Benefits and Eligibility Specialist

Family & Children's Services; Tulsa (OK); On-site; USD 38,000 - 54,000; Full time

Job summary

Family & Children's Services in Tulsa seeks an Insurance Eligibility Specialist to help clients access Medicaid and other insurance options. You will assist with applications, collect documents, enter data into EHR, and support timely reimbursements.

Responsibilities include determining eligibility, guiding enrollment, handling questions, ensuring completeness, and coordinating with staff and outside entities to resolve issues.

Qualifications

• Must be a high school graduate or have HS equivalent.
• Associate's degree preferred.
• Experience in Medicaid eligibility, enrollment and billing is strongly preferred.
• Customer service experience is preferred.
• Knowledge of HIPAA and Medicaid/ODMHSAS rules.

Responsibilities

• Determine client eligibility for Medicaid, Medicare, or other applicable insurance programs.
• Provide information, application assistance, and enrollment assistance in a timely manner to clients seeking healthcare coverage.
• Handle questions and provide detailed information on requirements, processes, and policies.
• Ensure applications are completed correctly with all required materials.
• Secure necessary documentation to enroll clients in applicable programs.
• Generate and complete assigned reports using EHR, Report Manager, and PICIS.
• Verify and update client data in the EHR for accuracy and completeness.
• Collaborate with staff and outside entities to correct errors and resolve issues.

Skills

Typing Advanced

Excel Some Knowledge

Detail Oriented

Communication Skills

Time Management

Organizational Skills

Confidentiality

Education

Associates or better

High School diploma or equivalent

Job description

Competitive salary, exceptional benefits and 34 paid days off to start!

Join an amazing team helping others everyday

JOB SUMMARY:

Serve as an advocate for FCS clients to access health insurance made available through the state Medicaid program or other applicable insurances. Responsible for assisting clients with insurance applications, handling or collecting related documentation, demographics and other relevant information, entering data and/or information collected into EHR, and providing excellent customer service. Responsible for ensuring optimal and timely reimbursement by maintaining accurate client eligibility information and resolving errors before claims are filed.

POSITION SPECIFIC DUTIES & RESPONSIBILITIES:

• Determine client eligibility for Medicaid, Medicare, or other applicable insurance programs.
• Provide information, application assistance, and enrollment assistance in a timely manner, to any clients seeking healthcare coverage.
• Handle questions, issues and provide detailed information on requirements, processes, and policies.
• Ensure applications are completed correctly and that the required supporting materials have been provided.
• Secure necessary documentation to enroll clients in the applicable insurance program(s) (i.e. Authorization & Releases, Income Documentation, Tax Documentation, proof of insurance ineligibility, etc.)
• Generate and complete assigned reports, adhering to established schedules and completion timelines, utilizing the electronic health record system, Report Manager, and PICIS.
• Ensure accuracy of data submitted to guarantors and state agencies, by reviewing, verifying, and updating client information in electronic health record system, including demographics, financial eligibility, services, diagnoses, and authorizations.
• Communicate and collaborate with other agency staff and outside entities, in order to correct errors, resolve issues, and provide assistance to staff both within the department and throughout the agency.

QUALIFICATIONS

EDUCATION:

• Must be a high school graduate or have HS equivalent
• Associate's degree preferred

EXPERIENCE:

• Experience in Medicaid eligibility, enrollment and billing is strongly preferred.
• Customer service experience is preferred

PERFORMANCE COMPETENCIES:

• Client and Public Engagement/Customer Service
• Generate and Deliver Reports
• Process and Procedures
• Billing compliance and Accurancy

KNOWLEDGE/SKILLS/ABILITIES:

• Requires a strong understanding of current Medicaid and ODMHSAS rules and regulations in regards to behavioral health, along with knowledge and understanding of HIPAA laws and client privacy.
• Proficient in communication, internal and external customer service, and time management.
• Strong organizational skills and attention to detail is a must.
• Ability to function independently and to maintain an effective working relationship with agency employees.
• Must be efficient, timely, and accurate in all duties and responsibilities.
• Must conduct self professionally, maintain confidentiality, and have strong computer skills, including proficiency in Excel.

CERTIFICATIONS/LICENSES:

• Must possess a valid Driver License and satisfactory driving record and use personal automobile to travel to locations other than primary office. Proof of automobile insurance required.

SAFETY SENSITIVE JOB CLASSIFICATION: This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Due to the “safety-sensitive” classification, an employee in this position would be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process or the consequences of testing positive for marijuana per the Family & Children’s Services Drug Free Workplace Policy, including possible revocation of a job offer or dismissal from employment.

Qualifications

Skills

Required

• Typing Advanced
• Excel Some Knowledge

Behaviors

Required

• Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well

Education

Required

• Associates or better.
• High School or better.

Experience

Preferred

• 1 year: Mental Health
• 1 year: Experience with Medicaid eligibility and enrollment is strongly preferred.

Licenses & Certifications

Required

• Drivers License
• Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
  This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.