Network Benefits Specialist

General Summary:

Under the direction of the Supervisor, Outpatient Billing Services, the Network Benefits Specialist ensures consumer insurance information is accurate and up to date in the electronic medical records (EMR), and assists with determining whether or not applicants for various programs meet the necessary qualifications. The Network Benefit Specialist provides direct support, if necessary, for the application process; as well as, follow up of submission and review of process. This position also ensures consumers maintain their benefits by tracking of all Medicaid programs. The Network Benefits Specialist usually works with Community Mental Health Services Programs (CMHSP) providers, individuals and families, as well as other governmental agencies. This function involves fact checking, record keeping, and advocacy on behalf of individuals.

Essential Functions:

• Conducts 'chart scrubbing' to ensure insurance information is current and accurate.
• Completes Medicaid applications upon intake for all Lifeways consumers, as necessary.
• Completes assigned shared job functions (Medicaid Deductible/Family Support Subsidy) timely, and submits to MDHHS as required
• Reviews applications for various aid programs and ensure that applicants are eligible. This entails assisting with the completion of the application process and/or verifying that any application forms have been filled out correctly and checking the information on the forms for accuracy. This may require specialist to follow up with applicants multiple times; these meetings generally occur in Jackson and Hillsdale counties, but travel within the State of Michigan may be necessary, to ensure deductibles are met in a timely manner.
• Verifies insurance information in the Lifeways Electronic Medical Record (EMR), adding and updating insuance layers.
• Ensure appointment are scheduled correctly based on physician credentialing.
• Manages as assigned Medicaid deductible cases for Jackson and Hillsdale counties. This is a shared job function, with one primary staff and one back-up as assigned by Supervisor.
• Manages Family Support Subsidy program, as assigned, for Jackson and Hillsdale counties. This is a shared job function, with one primary coordinator and one back-up as assigned by Supervisor.
• Analyzes data to identify trends and areas for improvement in relation to consumer benefits eligibility/Medicaid status report/General Fund. Based on data collection and analysis, specialist will report outcomes that demonstrate improvement in overall percentage of consumers maintaining eligibility.
• Monitors quality of Ability to Pay (ATP) and Financial Determination process throughout the LifeWays Provider Network in addition to managing Financial Determination verification for provider network.
• Serves as Ability to Pay and Financial Determination specialist, to answer questions from LifeWays staff and LifeWays Provider Network concerning Ability to Pay situations and /or problems concerning ATP/Financial.
• Responsible for documentation and paperwork as well as computerized record keeping. In addition to preparing and maintaining client files, keeps track of client appointments and any changes in the policies of their organization.
• Assists individuals in applying for Social Security benefits (SSI, SSDI, SSA, Medicare, Medicaid).
• Acts as an information resource to people who need financial assistance. Provides education and advocacy by advising people on what aid programs may benefit them and then helping them receive that benefit.
• Meets with consumers as needed at home, hospital, LifeWays, etc. Travel is required. These meetings generally occur in Jackson and Hillsdale counties, but travel within the State of Michigan may be necessary.
• Assists with Insurance authorizations.
• Maintains regular and predictable attendance.

Required Education/Certification/Licensure:

• Associate's degree in Human Services or related field, or a minimum of 2 years if related job experience
• Safety Care training, upon hire.
• MI Bridges training, upon hire.
• SSI/SSDI Outreach, Access, and Recovery (SOAR) training, upon hire.
• Mental Health First Aid Training, upon hire.
• Must have reliable transportation*
• Experience with various Insurance portals.

Preferred Education/Certification/Licensure:

• CPR and First Aid Training.