HUMAN SERVICES PROGRAM CONSULTANT II - 64081911

State of Florida • Orlando, FL

1d • Onsite

About The Position

This is a highly responsible position in the Ryan White HIV/AIDS Program (RWHAP) Part B AIDS Drug Assistance Program (ADAP) at the Sunshine Care Center (SCC) of the Florida Department of Health in Orange County. The incumbent serves as the Lead ADAP worker and shall be responsible for coordinating work and providing on-going guidance to the ADAP team after new employee orientation; provide training to new ADAP workers; review enrollments completed by other ADAP workers to ensure accuracy. Analyzes programmatic reports to ensure completeness & accuracy per approved standards. Communicate with Broward Region Health Planning Council regarding complex ACA health insurance enrollment. Develop monitoring, compliance reviews and/or quality assurance techniques for measuring the quality-of-service delivery to ensure maximum efficiency in collaboration with the ADAP Supervisor.  The incumbent is responsible for ensuring efficient operations of the team during staff shortages in conjunction with the ADAP Supervisor.  Identifies improvements and adjustments to ensure program effectiveness and efficiency. This position works with a high volume of clients for patient care services within the ADAP Unit and is responsible for solving complex ACA, Private, COBRA, Medicare and Medicaid enrollment issues.  Interviewing clients, analyzing and determining the eligibility of clients for the ADAP Direct Dispense or the ADAP Premium Plus programs. All services provided will be documented in all electronic data management systems required by DOH-Orange, state program office, and RWHAP Part B ADAP Services (e.g. Health Management System [HMS]), ADAP Provide Enterprise [PE], RWHAP Part B Portal)

The incumbent will interview clients, review records, conduct consultations, and analyze data to measure the effectiveness of programs. The incumbent will ensure the PE database contains all necessary documentation (e.g. on-time recertification, medication pickup, viral load suppression, Affordable Care Act [ACA] enrollment). This position works in partnership with Case Management Team, Peer Navigator Team, Targeted Outreach for Pregnant Women Act (TOPWA) Team, Nursing Team, and Medical Providers on a Patient Centered Care Team Model in provision of clients’ medical care.

Requirements

• Current DOH employee
• At least 5 years of verifiable experience performing data entry utilizing an electronic medical record.
• At least 5 years of verifiable AIDS Drug Assistance Program experience.
• At least 5 years of verifiable experience interviewing/counseling clients.
• At least 5 years of verifiable experience processing the copayments and deductibles of various types of insurance to include Medicare, Medicaid, private insurance, ACA Health Insurance, or VA Insurance Premium.
• Authorized to work in the United States without employer sponsorship.
• Willing to physically come into the office daily to perform the duties & responsibilities of the position.
• Incumbent has never been debarred, suspended, or excluded from any federal assistance programs.
• Emergency Duty.
• Basic computer skills.
• Able to read laboratory reports, prescriptions and familiar with medical terminology.
• Professional Communication skills to communicate with providers and general public.
• Knowledge of all available funding sources for HIV medication.
• Experience with the Aids Drug Assistance Policy, Payor of last resort and HRSA/HAB guidelines.
• Knowledge of insurance terminology.
• Ability to analyze documentation and document.
• Communicate with Case managers, Medical, Pharmaceutical and BRHPC.
• Ensure Ryan White HIV AIDS Program (RWHAP) is the Payor of last resort.
• Knowledge of community resources/agencies.
• Ability to identify a need on a client and coordinate services.
• All Florida Department of Health positions require the incumbent to be able to learn and communicate effectively, orally and in writing, in English.

Responsibilities

• Coordinate work and provide guidance to the ADAP team after new employee orientation
• Provide training to new ADAP workers
• Review enrollments completed by other ADAP workers to ensure accuracy
• Analyze programmatic reports to ensure completeness & accuracy per approved standards
• Communicate with Broward Region Health Planning Council regarding complex ACA health insurance enrollment
• Develop monitoring, compliance reviews and/or quality assurance techniques for measuring the quality-of-service delivery
• Ensure efficient operations of the team during staff shortages
• Identify improvements and adjustments to ensure program effectiveness and efficiency
• Interview clients, analyze and determine the eligibility of clients for the ADAP Direct Dispense or the ADAP Premium Plus programs
• Ensure the PE database contains all necessary documentation
• Determine ADAP Eligibility
• Maintain and manage the RWHAP Part B portal to ensure up-to-date documentation
• Maintain caseload of at least 150 clients
• Interview clients, review records, and confer with medical providers and case managers to evaluate clients’ adherence
• Counsel clients individually to assist in overcoming deficiencies regarding transitioning to ACA health insurance coverage; handling co-payments and deductibles as well as adjusting to life and making changes
• Educating clients on Medicare Parts C and D and their co-payments and deductibles
• Complete ADAP enrollment or re-enrollment
• Collect insurance and support documentation per program requirements
• Document progress notes in databases per program requirements
• Collaborate with case managers, physicians, and pharmacies to ensure program requirements are met
• Communicate with health insurance companies regarding client’s co-pay, deductible and medication coverage
• Expertly navigate and resolve intricate coverage challenges across the Private health insurance, Affordable Care Act Marketplace, COBRA continuation, and Medicare programs.
• Provide training to new staff members and retraining of current staff as necessary
• In collaboration with the Supervisor, review enrollments and develop monitoring tools to measure the quality of services provided
• Contacting clients regarding Medication pickup for Direct Dispense and retail clients
• Contacting clients regarding expiring or expired ADAP eligibility
• Updating Clients lab in the Provide database every six months
• Analyzing data to measure the effectiveness of programs
• Perform other related duties as assigned

Benefits

• Annual and Sick Leave benefits
• Nine paid holidays and one Personal Holiday each year
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
• Retirement plan options, including employer contributions
• Flexible Spending Accounts
• Tuition waivers

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed