Intake Worker And Benefit Specialist

La Clínica del Pueblo

Job Description

Job Title:Intake Worker and Benefits Specialist

Department: Patient Services

Supervisor: Health Center Manager

Location: Washington, DC

Classification: Non-Exempt/Hourly

Synopsis: The primary responsibility of the Intake Worker and Benefits Specialist (IW&BS) is to ensure LCDP patients (uninsured or underinsured) understand by providing educational outreach and successfully applying for Medicaid, Medicare, or commercial insurance. The IW&BS will seek to maximize benefits available in private and public programs to preserve LCDP’s discount as the payer of the last resort. The IW&BS is responsible for the registration, insurance enrollment, benefits, and eligibility, collecting income, residential, and identification documents to determine sliding fee scale eligibility for La Clinica del Pueblo’s patients.

Qualifications Required Education and Experience

• High School diploma or GED equivalent
• One to two years of registration or data entry equivalent in a healthcare setting
• Proficiency in Microsoft Office and electronic health records

Preferred Education and Experience

• Knowledge of the DC / Maryland (based on job site), Medicaid Program, public assistance benefit application, insurance verification, and Benefits/eligibility
• Experience in a healthcare setting within insurance/billing and claims resolution
• Assisting the public with enrollment in health insurance programs
• Working with the Latino, LGBTQ+, and Ryan White communities; and with the uninsured and underserved populations

Required Skills/Abilities/Certifications/Licenses

• Achieve and maintain certification in DC Health Link and Affordable Care Act credentials within six (6) months of employment; and annually after that.
• Obtain other credentials as required and maintain expertise through continuing education.
• Strong oral and written communication skills; bilingual in English and Spanish

Preferred Skills/Abilities/Certifications/Licenses: N/A

Duties and Responsibilities

• Responsible for verification of patient insurance eligibility daily. Establish and maintain all verification records for audit purposes. Uses real-time work list to prioritize workload.
• Assists patients with their application and determining eligibility for Medicaid. Assists patients with understanding web-based decision tools to help narrow the choices for qualified health plans.
• Explains and ensures patients understand their health plan options, affordability programs, Qualified Health Plans, Essential Health Benefits, and rights when using insurance. Explains Medicaid and DC Healthcare Alliance Programs and eligibility requirements to patients.
• Assists patients with appeals, grievances, and complaints by referring them to the appropriate agency. Makes referrals as needed to the DC Alliance, a broker, or government and community resources tracks these referrals in the consumer database and documents them in eCW.
• Assists uninsured or underinsured patients with the Sliding Fee Scale application process. Explains the requirements and their responsibility to report when life changes occur and upcoming renewal dates.
• All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately in the patient’s medical record in eCW.
• Assists staff and other appropriate departments regarding benefits and eligibility.
• Supports and collaborates with the Health Center Manager to track all pending Medicaid/Alliance applications. Tracks activities in eCW and other databases as requested. Assists with preparing reports for the DC Health Benefit Exchange or HRSA as needed.
• Adheres to all HIPAA Guidelines. Maintains a safe, secure, and healthy work environment by following standards, procedures, and guidelines.
• Conducts registration, data entry, and recertification with new or re-admitted patients. Gathers required information, assists patients in completing paperwork, verify family income and size, and assigns them appropriately on a sliding fee scale.
• Able to explain billing policies and service fees to patients.
• Enrolls and informs patients on the DC and MD Health Benefit Exchange program specifications and other health coverage programs such as Medicaid, Medicare, ADAP, MADAP, and DC Healthcare Alliance. Recertifies ADAP/MADAP applications and follows up on applications. Tracks and monitors patient’s eligibility and recertification of health insurance and pharmacy coverage (Drug Assistance Programs) every six (6) months.
• Attends ongoing training and meetings with the Care Coordinators and the medical team to ensure they meet the Ryan White, My Health GPS, and other external criteria and the medical home requirements.
• Based on weekly reports, initiates corrective action as necessary to ensure accuracy and completeness of information per goals and program requirements.
• Provides excellent internal and external customer service via telephone or face-to-face interactions to assist patients and LCDP staff.
• Attends monthly staff meetings and all LCDP mandatory activities
• Other duties as assigned.

Supervisory Responsibilities:None

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times

Benefits:

• 403B
• Health insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Transportation Benefits
• Tuition Reimbursement
• Paid Vacation Time
• Employee Assistance Program
• FSA and DCFSA

Equal Opportunity Employer. We affirm all identities at La Clínica and expect all employees to welcome and work with colleagues and clients, regardless of sexual orientation, gender identity, race/ ethnicity, country of origin, language, other ability, age, religion, or other identity.