Job Description

JOB SUMMARY:

Takes direction from the Entitlement Services supervisory/management staff in the carrying out of assignments that include the processing maintenance and completion of assignments of the following Entitlements Specialist Coordinator job tasks and responsibilities.

ESSENTIAL JOB FUNCTIONS:

DELIVERY OF ENTITLEMENT SERVICES TO INTEGRATED SERVICES CLIENTS

• The Specialist focuses on Medicaid eligibility.
• The Specialist identifies clients with entitlement-related issues and processes their cases in accordance with Entitlements Department policies procedures and requirements.
• The Specialist provides entitlement services to community-based clients by gathering and analyzing relevant information including household composition and determining appropriate next steps.
• The Specialist assists clients with verbal and written communications with relevant agencies including HRA NY State and SSA to establish and maintain Medicaid eligibility.
• The Specialist maintains a thorough understanding of Medicaid enrollment recertification and disenrollment from HMO processes including ongoing documentation requirements for client income and financial resources.

MAINTAIN ENTITLEMENT CASE RECORDS :

• Maintains entitlement records in a timely and accurate manner by promptly filing all entitlement correspondence inter- and intra-agency documents and informational materials related to the entitlement cases of community-based clients receiving Integrated Services.
• Maintains an up-to-date and accurate written record in the Contact Notes section of the client case record of all Entitlement interactions with the client and with all the entitlement systems and inter- and intra-agency contacts pertaining to consumers entitlement case.
• Utilizes the Entitlement case record as an analytical tool to be able to efficiently access entitlement information when problems arise and for other purposes e.g. statistical surveys departmental reports etc. and can use this resource to problem solve and to present this information for supervisory review.
• Archives hard-copy files in compliance with records retention policies.
• Maintains all additional ICL Entitlement forms medical insurance forms and procedures that may be developed to enhance the full range of maintenance of case records task.

MAINTAIN THE MONTHLY ENTITLEMENTS RECORDS

• To develop and maintain tracking system that allows to keep accurate and up-to-date monthly Entitlements Recertification and Renewal data.
• Maintains an accurate and up-to-date monthly submission of bills for Medicaid Surplus consumers or to recover Medicaid Retroactive Coverage
• Maintains all additional ICL forms and procedures that may be developed to enhance these recording and analytical tasks.

MAINTAIN AND UPDATE THE LATEST DEVELOPMENT IN ENTITLEMENT BENEFITS

• The Specialist can utilize and integrate any new entitlements information accessed using electronic and other media (such as: PDR - the Physicians Desk Reference POMS the collection of SSA rules and regulations HRA Policy Directives ACCESS HRA) in his ongoing case management activities.
• The Specialist can utilize any type of resources to prepare presentations for consumers and clinical staff.
• Maintain the electronic data system and uses e-mail service daily

MAINTAIN DAILY CLOSE INTERDEPARTMENTAL RELATIONSHIP WITH THE VARIOUS ICL DEPARTMENTS AND IS ABLE TO FULLY UNDERSTAND AND PROCESS THE FINANCE REPORTS AND THE ADDITIOANAL FORMS AND PAPERWORK THAT ARE REGULARLY ISSUED :

• The Specialist collaborates closely with the Billing Department and Integrated Services staff.
• The Specialist can read and understand the regularly ICL - issued reports and is able to integrate the reported information into his or her ongoing case management activities.
• The Specialist can analyze Finance reports (including Medicaid Denial Report) research individual consumers information and determine further actions.
• Maintain an on-going contacts with other ICL Departments programs staff clinical managers and doctors to maintain accurate and up-to-date clients case management activities.

DEVELOP AND MAINTAIN COLLATERAL CONTACTS :

• Access develop and maintain collateral agency contacts and relationships to better process entitlement information and documents to establish and maintain consumers Medicaid eligibility.
• Utilize these collateral agency contacts as an on-going resource for additional entitlement knowledge and as a means of expanding and enhancing the Specialists advocacy skills.
• Communicate in an effective manner both orally and in writing with wide range of collateral agencies to initiate maximize and continue the consumers entitlement benefits and services. Be able to effectively communicate with the highest level of collateral staffs such as: AA to the Director Supervisor or Manager to ensure the clients benefits cases are processed timely and in an efficient manner.
• Serve as a client advocate in front of SSA court and at PA Medicaid Fair Hearings. Collect and process all medical documentation and forms used to help ICL consumers during their Hearings.
• Maintain all additional ICL Entitlement forms and procedures that may be developed to enhance these collateral contact tasks.

PROVIDE ENTITLEMENT COUNSELLING TO RESIDENTS AND CLINICAL STAFF :

• Maintain scheduled Entitlement counseling meetings for the purpose of providing entitlement outreach and advisement to both consumers and staff.
• The Specialist should be able to provide individualized benefits advisement services to consumers which includes collecting the data analysis and a recommendation to the individual.
• The Specialist would educate participants on proactive steps to maintain coverage such as completing renewals on time reporting changes in income or household status responding to notices and understanding available resources when coverage is at risk.
• Can communicate effectively and sensitively with both residents and staff and is particularly attuned to the residents varied and changing abilities to process the often difficult and complex entitlement information .
• Maintain all addition Sal ICL Entitlement forms and procedures that may be developed to enhance these counseling and reporting tasks.

ATTEND ALL SCHEDULED ENTITLEMENT SUPERVISORY AND BENEFITS TRAININGS :

• Actively participate in the supervisory process. The Specialist can utilize supervision by taking direction regarding the daily processing and completion of assigned departmental tasks. Through trainings the Specialist should enhance and expand his entitlement knowledge and the skills necessary to effectively work with residents agency staffs and the various benefit systems.
• Attend various benefits training sessions be able to understand and comprehend the ever-changing Entitlements operation procedures relay the subsequent information to the co-workers and utilize it in Specialist day-to-day work.

QUANTITY AND QUALITY OF WORK STANDARD :

Regarding all the tasks described above it is recognized that the pressure of work can often be very intense and that it is often impossible for a specialists work to be completed by the end of the usual workday. Nonetheless it will be expected that the Entitlements Specialist Coordinator after a certain time and experience on the job (approximately after the initial six to eight months) will be able to make reasonable judgments as to which work tasks should be completed sooner rather than other words the counselor should be able at this point to prioritize their range of tasks. The counselor should be able therefore to organize a paperwork and case management triage system and process for themselves that will not jeopardize either a residents entitlement benefits or the entitlement revenue returns to the agency.

ESSENTIAL KNOWLEDGE SKILLS AND ABILITIES:

• Committed to equity diversity inclusion and belonging and active promotion of the ICL values and goals.
• Excellent verbal and written communication skills along with developed computer literacy
• Ability to design forms for the collection of information
• Highly organized and detail-oriented
• Ability to complete tasks in a timely manner
• Ability to identify problem and analyze it
• Ability to multitask prioritize work and perform under stress
• Willingness to expand knowledge base
• Positive attitude and excellent customer service skills

QUALIFICATIONS AND EXPERIENCE:

Bachelors degree (B.A.) plus 2 years experience in social/human services (providing services to individuals with psychiatric disabilities a plus) entitlement or related area of service or Associate degree plus 3 years of above experience or High School diploma/G.E.D. plus 4 years of above experience.

Required Experience:

IC

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