Entitlement Coordinator

SCCMHA JOB VACANCY ANNOUNCEMENT

CLASSIFICATION:
Entitlement Coordinator

PAY GRADE: $24.19 - $28.17 Hourly

POSITION SUMMARY:

Under the general supervision of the Entitlements Supervisor, this position is responsible ensuring that SCCMHA consumers obtain the maximum health insurance benefit for which they are eligible. This objective is accomplished through monitoring of enrollment data, assistance with applications and facilitation of communications with relevant agencies such as the Department of Human Services. Assesses consumer’s Medicaid eligibility based on MPHI and the data exchange gateway (DEG) and determines appropriate waiver linked to the eligibility for identification of the mental health benefits available to the consumer.

This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid consumer in the recovery process.

ESSENTIAL DUTIES AND RESPONSIBLITIES:

1. Maintains and monitors eligibility in both individual consumer health records and in large databases. Compares data from different sources to ensure accurate information is used for fund source allocation for services provided. Coordinates and maintains consumer eligibility records between MPHI, the DEG, and the consumer’s SCCMHA financial assessment database in order to assist access center and the finance department to allow for the proper fund source allocation of services received by consumers.

2. Completes required forms on open clients within the agency and those referred to outside providers.

3. Processes, enters, retrieves, and verifies consumer Ability to Pay/ Sliding Fee information.

4. Runs comparison reports between sources of insurance information MPHI, the DEG, and the consumer’s SCCMHA financial assessment database to determine if variances occur in the data. Researches all variances and makes corrections to the information as needed. Answers questions regarding eligibility records.

5. Provides support to DHS outstation workers staff for individual consumer applications ; help eliminate unnecessary delays related to Medicaid determinations by monitoring all pended applications and follows up with DHS when determinations result in a denial of Medicaid eligibility.

6. Assists with the maintenance of the spreadsheet to track SCCMHA consumers Medicaid deductible (spend down) information and assist case managers in completing deductible forms to submit to DHS.

7. Scans all Medicaid information into Sentri consumer file.

8. Provides additional financial assessments as necessary. Maintains recipient eligibility records of all funding sources (Medicaid, Medicare, BCBS, HMO’s, MI-Child, Categorical, etc.) within the system database, as needed. Verifies Medicaid eligibility through the state’s Michigan-Access software application, and works with Health Home Specialist, and CAI Administrative Assistant to resolve eligibility questions.

9. Provides training to clinical staff as needed regarding the Medicaid application process and eligibility regulations.

10. Treats all consumer protected health information (PHI) with strictest confidence and handles this information as required by the SCCMHA adopted HIPAA rules and regulations.

11. Maintains a professional office setting at all times and organizes workflow in an effective and efficient manner, and completes all other duties as assigned.

12. Is familiar with and can assist consumers with obtaining Medicare Part D benefits when open enrollment occurs.

13. Works with providers in the SCCMHA network to answer questions regarding Medicaid and other entitlement benefits for consumers.

14. Reviews policies and procedures as they relate to work with consumer entitlements.

15. May be asked to present information about entitlements in various venues.

16. Assists with other duties as they pertain to insurance eligibility as well as departmental workflow.

17. Adheres to the mission, vision, core values and operating principles of SCCMHA…