Eligibility Specialist

Family First Health is seeking a Case Manager for our York location. As a Case Manager at Family First Health, you should have a positive and outgoing personality, the ability to learn and teach back new programs, excellent customer service skills, and strong organizational skills. 

This position is more than just a job, it’s an opportunity to learn and grow with a terrific team. We’re dedicated to offering trustworthy service and care. The Case Manager position will play a large role in that. If this sounds a like a good fit, we would love to hear from you. 

EMPLOYEE BENEFITS 

• 3 Weeks of Paid Vacation per year 
• 6 Days Paid Sick Leave Time per year 
• 4 Personal Days per year 
• No Late Evenings or Weekend Hours 
• Paid Time Off on Holidays 
• Health, Dental, & Vision Insurance Plans 
• Short/Long Term Disability and Life Insurance 
• 403(b) Retirement Plan 
• Tuition Reimbursement Opportunities 
• Attention to work-life balance 
• Opportunity for growth and advancement 
• And More!

 ESSENTIAL DUTIES AND RESPONSIBILITIES

• Works directly with clients of the Caring Together Program of Family First Health to provide benefit counseling, eligibility services, and certification compliance to patients with HIV/AIDS.
• Screens and evaluates clients for potential eligibility for assistance programs and makes referrals to community resources as needed.
• Explains forms, program guidelines, terminology, and answers questions regarding benefit programs to clients. These include but are not limited to: the Special Pharmaceutical Benefits program, Medical Assistance, Medical Assistance for Workers with Disabilities, Healthy York Network, the Affordable Care Act (ACA)/Marketplace, Medicare, Social Security benefits, the AIDS Waiver, and the Family First Health reduced fee program.
• Interviews patients and assists with applications, interviews, appointments, appeals, hearings, and all other necessary steps to obtain certification for medical coverage.
• Reviews benefit applications submitted, identify missing required client data, and verify what must be collected in support of the eligibility determination.
• Gathers detailed client demographic, residency, medical, insurance, and income based information related to applications for public assistance programs and the Department of Health Part B and Ryan White Part C certification process.
• Adheres to all Ryan White program regulations and policies.
• Maintains timely and accurate documentation of service provision including tracking of Caring Together client insurance status and Part B and C certification status.
• Communicates with Caring Together interdisciplinary team, peers in other departments, managers, executives, patients and families, and other community agencies to ensure ongoing medical care for clients, to maintain connectedness, and for positive internal/external customer service.
• Maintains ACA Navigator status and attends trainings, webinars, and conference calls specifically related to the ACA.
• Identifies, develops, coordinates, and conducts targeted outreach, education, and linkage to HIV medical care for current, out-of-care, non-compliant, or newly diagnosed Caring Together clients and assists in retention efforts for currently enrolled clients.
• Maintains timely and accurate documentation of service provision, evaluation, and statistical data for the HIV outreach program; including detailed client demographics, medical information, risk factors, and other information needed related to grant reporting. 
• Conducts client home visits to assess their barriers to HIV care, if needed, in a safe and constructive manner.
• Attends yearly case management training regarding public benefit changes, seeks out new trainings as needed, and attends internal trainings as required.
• Attends and actively participates in both internal and external meetings as required. 
• Maintains a high level of patient confidentiality.
• Assists with HIV outreach activities as needed. This may include Consumer Advisory Board activities (CAB), HIV education, performing rapid HIV testing, and/or pre and post-test HIV counseling.
• Maintains working files for Caring Together clients who complete the Part B/C certification process but do not access case management services.
• Assists the Family First Health patient benefits department during Affordable Care Act open enrollment as needed.
• Performs all other duties as assigned. 

KNOWLEDGE/SKILLS/ABILITIES

• High School Diploma or equivalent with some relevant experience in obtaining the necessary information from clients either in a healthcare, hospital, or government setting
• Knowledge of computer software applications (Microsoft Office Applications, others)
• Knowledge of grammar, spelling, and punctuation as it relates to correspondence necessary to perform essential job functions
• Knowledge of basic arithmetic to make calculations, balance and reconcile figures necessary, and make changes accurately
• Excellent customer service skills
• Ability to travel between work sites and home visits by retaining a valid driver’s license and current automobile and reliable transportation
• Ability to critically think which means the ability to think clearly and rationally about what to do or what to believe; understand logical connections between ideas; and identify, construct, and evaluate arguments
• Ability to set positive examples for team members through exceptional work performance including adherence to company policies and processes.
• Ability to work independently and within a multidisciplinary team
• Ability to work in, and respond appropriately to a demanding environment including crisis situations
• Ability to appropriately handle sensitive and confidential information
• Ability to communicate well and in a caring and supportive manner with individuals of all backgrounds.
• Ability to work efficiently and accurately with strong attention to detail
• Ability to sort and file materials correctly by alphabetic or numeric systems
• Ability to establish and maintain effective working relationships with patients, employees, volunteers, and the public
• Ability to be organized, proactive in follow-up and follow-through, and to juggle multiple competing tasks
• Ability to adhere to all Family First Health’s policies, processes, and procedures, especially, Code of Conduct, Workplace Conduct, and the Remote/Telework Policy if indicated eligible to work remotely or telework.
• Ability to articulate and advocate Family First Health’s mission and values
• Ability to maintain required clearances and licensure.

PHYSICAL DEMANDS

Mental/Physical Requirements: Must possess the physical and mental abilities to perform the tasks normally associated with an Eligibility Specialist position such as:

• Frequent exposure to disease, infection, virus, blood, and bodily fluids
• Frequent and prolonged work at a computer and/or on the phone for extended periods of time with repetitive typing, arm and hand motion
• Requires correct vision and hearing to normal range
• Frequent travel between work sites and home visits with exposure to weather conditions
• Frequent contact with patients and others in their homes under a wide variety of circumstances
• Subject to varying and unpredictable situations
• May be exposed to/occasionally exposed to patient or environmental elements such as but not limited to pets, pests, weapons, drugs, or poor home maintenance
• Occasional lifting and carrying of supplies and equipment
• Frequent competing demands, frequent changes, delays, or unexpected events
• Frequent use of common PPE/safety equipment
• Frequent bending, standing, stair climbing, walking, turning and reaching
• Occasional stooping, crouching, kneeling or bending
• When teleworking or working remotely, requires working alone in a qualified work setting

COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance