Benefits Eligibility Specialist

Healthcare For the Homeless•Baltimore, MD

19h•Onsite

About The Position

Health Care for the Homeless is seeking a Benefits Eligibility Specialist to join their mission-driven team. This role is responsible for educating, advocating, and counseling clients in navigating Maryland state and federal insurance processes. The specialist will serve as a subject matter expert on Medicaid and Medicare insurance, working with practice operations, billing staff, and clinical staff to affirm insurance status and provide guidance on coverage inquiries. The position offers the opportunity to do meaningful work in a collaborative, equity-centered environment focused on community wellness and ending homelessness.

Requirements

High School Diploma or GED required.
Certified Application Counselor, or able to obtain certification within the first six months of hire (BES I).
Certified Health Navigator, or able to obtain certification within the first six months in role (BES II).
One year of experience working with insurance eligibility/verification or similar role required (BES I).
Two years of experience required (BES II).
Experience in a community or public health setting working with an underserved population is highly preferred.
Experience working with multiple line telephone systems, computers, and practice management systems required.
Excellent customer service, with ability to clearly communicate verbally and in writing.
Must be able to maintain confidentiality in all circumstances.
Must be able to remain calm in highly inflammatory circumstances, providing and taking clear direction and maintaining a respectful demeanor.
High level of motivation, initiative, and responsibility.
Able to work with interdisciplinary teams.
Able to cope with interruptions, be flexible, and be a team player.

Nice To Haves

Bilingual (Spanish) highly preferred.

Responsibilities

Perform all duties of a Certified Application Counselor (BES I) or Certified Navigator (BES II) under the standards of the Maryland Health Benefits Exchange.
Interview applicants to screen for benefits eligibility, verify identity, and educate on required documentation and conditions to enroll, renew, modify, and prevent loss of insurance coverage.
Provide Health Choice/MCO Navigation and Medicare education in accordance with all state and/or federal guidelines, including explanation of plan options, program functions, requirements, affordability, cost-sharing structure, fees, penalties, and consumer rights.
Assist with enrollment into Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) options, Insurance Affordability Programs, Medicare, and Medicare Savings programs (Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary).
Assist eligible clients with completing applications, securing supporting documentation, and filing insurance applications.
Monitor and track client application, enrollment, and dates of coverage; conduct timely follow-up on cases/accounts, including making phone calls to clients or authorized representatives for missing information.
Consistently, accurately, and appropriately enter information into the electronic health record, Maryland State Connection portal, NGS Connex (Medicare), and Managed Care Organization portals.
Answer phone calls in a timely manner and respond to all voicemails within one business day.
Ensure timely behavioral health prior authorizations are approved for clients per MCO rules and before services are delivered.
Participate in continuing education training sessions, certification maintenance, and periodic insurance update meetings as required by the State of Maryland.
Maintain strict confidentiality of client and business information; comply with rules, regulations, policies, and procedures of all applicable agency, local, state, federal, and regulatory bodies.
Maintain expertise in eligibility and enrollment rules and procedures; the range of qualified health plan options and insurance affordability programs; the needs of underserved and vulnerable populations; and privacy and security standards.
Model and reinforce the Health Care for the Homeless core values of dignity, authenticity, hope, justice, passion, and balance.
Participate in performance improvement and advocacy activities that support the mission.
Perform other duties on an as-needed basis.
Protect clients’ personal health information by maintaining compliance with HIPAA and other relevant health care related IT security regulations.