Benefits Eligibility Coordinator

Health Care For the Homeless Inc; Baltimore (MD); Presencial; USD 48.000 - 75.000; Jornada completa

Descripción de la vacante

Health Care For the Homeless Inc. seeks a Benefits Eligibility Coordinator to lead a team ensuring clients access Medicaid/renewals and insurance benefits. You will supervise the Eligibility Specialists, coordinate with state agencies and MCOs, and ensure compliance with HIPAA and ADA regulations.

The role emphasizes training, performance tracking and efficient workflows within an integrated, multi-site health center environment, with a focus on underserved populations.

Formación

• Three years of experience in health insurance eligibility/verification.
• One year of supervision required.
• Experience with underserved populations preferred.
• HIPAA and ADA knowledge.
• Training in Motivational Interviewing preferred.

Responsabilidades

• Directly train, supervise and appraise a team of Benefits Eligibility Specialists.
• Perform duties of Benefits Eligibility Specialists, including navigator tasks.
• Coordinate with external entities for access to insurance benefits.
• Monitor, track and report Benefits Eligibility goals and KPIs.
• Ensure compliance with HIPAA, ADA and regulatory guidelines.
• Oversee and audit processes; align with Practice Managers across sites.
• Oversee prior authorizations for behavioral health per MCO rules.

Conocimientos

Team supervision

Training

Customer service

Communication

HIPAA knowledge

De-escalation

Motivational interviewing

Ethics

Educación

Associate’s degree

Certified Navigator

Herramientas

Practice management systems

Descripción del empleo

Department: Practice OperationsReports To: Director of Client AccessJob Family: Practice OperationsFLSA Status: ExemptEEO Classification: Administrative support workersSupervisor: YesLeadership Level: Emerging LeaderJob Function Status: Essential On-SiteOverviewThe Benefits Eligibility Coordinator works across an integrated multi-specialty federally qualified health center to ensure that clients are assessed for health insurance eligibility, and behavioral health providers have Medicaid MCO pre-certifications that enable them to be reimbursed for their services. The Coordinator maintains collaborative working relations with state and city entities to assist clients with access to insurance benefits.Key Role ResponsibilitiesDirectly train, supervise and appraise a team of Benefits Eligibility Specialists. Set, model and reinforce clear expectations, monitor outcomes, create a culture of open communication, and help team members solve complex problems through group and individual supervision.Perform and fulfill the duties and responsibilities of the Benefits Eligibility Specialists, including all duties of a Certified Insurance Navigator.Ensure a coordinated approach to assisting clients with access to insurance benefits in partnership with external entities, including the Maryland Health Benefits Exchange, Medicaid Managed Care Organizations, Health Care Access of Maryland (HCAM), the Department of Social Services and Medicare.Monitor, track and report upon Benefits Eligibility goals and key performance indicators. Implement and maintain efficient workflows, guidelines, and procedures. Ensure the team understands how benefits fit in the revenue cycle.Ensure compliance with applicable agency, local, state, federal and regulatory bodies and guidelines in day-to-day activities. Uphold terms of the HCAM practice entity agreement through regular audits.Coordinate with Practice Managers to align benefit eligibility processes, training and support across all sites.Oversee the process that ensures timely behavioral health prior authorizations are approved for clients per MCO rules. Coordinate with behavioral health providers to improve these processes and workflows, ensuring eligible clients receive authorization before services are delivered.Serve as an agency subject matter expert related to public health insurance. Provide consultation to managers and staff on insurance benefits, limitations and regulations.Model customer service excellence marked by culturally competent, client-centered, ethical, respectful, inclusive and professional access for clients, partners and the broader community.Knowledge, Experience and SkillsFormal Education and TrainingAssociate’s degree required of relative experience (equivalent combination of training and experience may be considered)Certification as a Certified Navigator (required within six months of hire)Training in Motivational Interviewing preferredTraining in De-escalation techniques preferredKnowledge of medical, administrative, ethical and the legal requirements of HIPAA and ADAExperienceThree (3) years of experience working with health insurance eligibility/verification or similar role requiredOne (1) year of supervision requiredFamiliarity working with underserved populations preferredExperience working with computers and practice management systemsSkillsAble to work independently, self-manage and meet deadlinesPossess good written and oral communication skillsAble to build a team, motivate staff and delegate tasks using a strengths-based approachWork collaboratively, resolve conflicts and provide thoughtful, constructive and actionable inputMaintain and safeguard confidentiality in a variety of settingsRemain calm, dependable and respectful, no matter the circumstanceAct with high ethical standardsProactively seek out training to learn and improveAble to cope with interruptions; flexible