Benefits and Eligibility Specialist

Family & Children's Services•Tulsa, OK

About The Position

Serve as an advocate for Family & Children’s Services (FCS) clients seeking health insurance through the state Medicaid program or other applicable insurance programs. Assist clients with insurance applications and enrollment, handle or collect related documentation and other relevant information, enter information into the electronic health record (EHR), and provide excellent customer service. Maintain accurate client eligibility information and resolve errors before claims are filed to support optimal, timely reimbursement. The position requires knowledge of current Medicaid and ODMHSAS rules and regulations related to behavioral health, as well as HIPAA and client privacy requirements. The employee must communicate and collaborate with agency staff and outside entities, maintain confidentiality, and work efficiently, accurately, and professionally. This is classified as a safety-sensitive position under the Oklahoma Medical Marijuana and Patient Protection Act. Employees are subject to drug and alcohol testing, including random testing. A medical marijuana license does not exempt an employee from testing or the consequences of a positive marijuana test under the employer’s Drug Free Workplace Policy.

Requirements

High school graduate or equivalent.
Strong understanding of current Medicaid and ODMHSAS rules and regulations related to 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.
Ability to perform duties efficiently, timely, and accurately.
Professional conduct and ability to maintain confidentiality.
Strong computer skills, including proficiency in Excel.
Valid driver license and satisfactory driving record.
Use a personal automobile to travel to locations other than the primary office; proof of automobile insurance is required.
Subject to drug and alcohol testing, including random testing, due to the safety-sensitive job classification.

Nice To Haves

Associate's degree preferred.
Experience in Medicaid eligibility, enrollment, and billing strongly preferred.
Customer service experience preferred.

Responsibilities

Determine client eligibility for Medicaid, Medicare, and other applicable insurance programs.
Provide timely information, application assistance, and enrollment assistance to clients seeking healthcare coverage.
Answer questions and explain insurance requirements, processes, and policies.
Ensure applications are completed correctly and required supporting materials are provided.
Obtain documentation needed to enroll clients in applicable insurance programs, including authorizations and releases, income documentation, tax documentation, and proof of insurance ineligibility.
Generate and complete assigned reports on schedule using the electronic health record system, Report Manager, and PICIS.
Review, verify, and update client information in the electronic health record, including demographics, financial eligibility, services, diagnoses, and authorizations, to ensure data submitted to guarantors and state agencies is accurate.
Communicate and collaborate with agency staff and outside entities to correct errors, resolve issues, and provide assistance across the agency.
Maintain accurate client eligibility information and resolve errors before claims are filed.