Benefits and Eligibility Specialist

Family & Children's Services Career Center•Tulsa, OK

About The Position

The Benefits and Eligibility Specialist advocates for Family & Children’s Services clients seeking health insurance through Medicaid or other applicable programs. The role assists clients with insurance applications and enrollment, gathers and processes required documentation and information, enters and maintains data in the electronic health record (EHR), and provides customer service. The specialist helps ensure accurate eligibility information and timely reimbursement by resolving errors before claims are filed. The position requires knowledge of current Medicaid and ODMHSAS rules and regulations relevant to behavioral health, as well as HIPAA and client privacy requirements. It is classified as safety-sensitive and is subject to drug and alcohol testing, including random testing.

Requirements

High school graduate or equivalent.
Strong understanding of current Medicaid and ODMHSAS rules and regulations regarding behavioral health.
Knowledge and understanding of HIPAA laws and client privacy.
Proficient communication, internal and external customer service, and time-management skills.
Strong organizational skills and attention to detail.
Ability to work independently and maintain effective working relationships with agency employees.
Must perform duties efficiently, promptly, and accurately; conduct oneself professionally and maintain confidentiality.
Strong computer skills, including proficiency in Excel.
Valid driver’s license and satisfactory driving record.
Must use a personal automobile to travel to locations other than the primary office and provide proof of automobile insurance.
Must comply with drug and alcohol testing, including random testing, as a safety-sensitive employee.

Nice To Haves

Associate’s degree.
Experience in Medicaid eligibility, enrollment, and billing.
Customer service experience.

Responsibilities

Determine clients’ eligibility for Medicaid, Medicare, or other applicable insurance programs.
Provide timely information, application assistance, and enrollment assistance to clients seeking healthcare coverage.
Answer questions and explain program requirements, processes, and policies.
Ensure applications are completed correctly and include required supporting materials.
Obtain documentation needed to enroll clients in applicable insurance programs, such as authorizations and releases, income and tax documentation, and proof of insurance ineligibility.
Generate and complete assigned reports according to established schedules and deadlines, using the EHR, Report Manager, and PICIS.
Review, verify, and update client information in the EHR, including demographics, financial eligibility, services, diagnoses, and authorizations, to ensure accuracy of information submitted to guarantors and state agencies.
Communicate and collaborate with agency staff and outside entities to correct errors, resolve issues, and provide assistance.