HUMAN SERVICES PROGRAM SPECIALIST - 64081085
About The Position
This position is a Ryan White Eligibility and ADAP Specialist for Area 3. This is a Career Service position that works directly with new and existing eligible for Ryan White Services and support across the 15 counties in Area 3/13. This position: • Performs eligibility services for the Florida Ryan White and AIDS Drug Assistance Program (ADAP). This is a highly sensitive position where easy access to HIV/AIDS services are essential, and information security is maintained following the need-to-know information security guidelines. The most current FL HIV AIDS Ryan White Part B Eligibility Procedure Manual, FL DOH Patient Care Program Administrative Guidelines, and the FL DOH ADAP guidelines and HRSA (federal) are utilized to perform duties. This is an area-wide position in the Ryan White Program which consists of 15 counties and may warrant occasional travel to other CHDs. The Human Services Program Specialist (HSPS) position for the Ryan White Eligibility and ADAP is under the supervision of the Regional HIV Patient Care and Treatment Access Coordinator at the FL DOH – Alachua. Duties include but are not limited to: • Enroll newly diagnosed and currently active HIV + clients in DOH Area 3, completing an annual enrollment for Ryan White Services and ADAP. Complete financial eligibility consistent with Florida HIV/AIDS Eligibility Procedure Guidelines and Ryan White Patient Care program guidelines. Document financial eligibilities in the FL Ryan White Patient Care Eligibility Portal, CareWare software systems, as well as HMS. Document ADAP in Provide Enterprise (PE) software systems and HMS. Verification of insurance, income, residency in accordance with DOH policy and Ryan White Eligibility manual is required. Conduct ADAP eligibility in accordance with ADAP eligibility manual and ensure appropriate documentation is uploaded in Provide software system. Upload most recent prescriptions, labs, insurance and other information as applicable in Provide software system as changes occur. Interviews pregnant women to determine eligibility for presumptive Medicaid benefits using manual procedures and a computerized Florida System. Assess clients for psycho-social needs such as Food stamps, housing, transportation, legal, mental health and substance abuse and refer as appropriate. Establishes liaisons with economic services staff to facilitate referrals, track dispositions, and assist clients in complying with the Medicaid application process. Serve as back up for Area 3 Staff and travel throughout Area 3/13 as needed. • Ensures eligibility and clinical data is entered timely and accurately following program guidelines. Enters viral loads and CD4 counts every 4-6 months into PE module to ensure viral suppression. Participates in ADAP monthly telephone conference calls. • Maintain knowledge of Medicare Part C & D programs, Affordable Care Act and private insurance programs. Maintain an understanding of adequate coverage based on ADAP standards, insurance terminology as well as an understanding labs.. Reviews applications for completeness and accuracy; advocating on behalf of clients with health insurance plan representatives, accountable care organizations, Medicare, Medicaid, The Centers for Medicare and Medicaid Services (CMS), and the Federal Insurance Marketplace; and disputes with health plans and other benefit programs. Processes disenrollments. Maintains expertise and knowledge in other benefit programs, including Medicare, Medicaid, SSI, SSDI, and other federal and state categorical assistance programs. Conveys information to case managers, field staff and medical providers. • Collaborate with community-based organizations and pharmacy personnel to ensure continuity of care. • Complete EARS Weekly; attend and participate in staff meetings and trainings. • Performs all other related duties as requested.
Requirements
- Must have knowledge, skill, and ability to use Microsoft Office Programs.
- Must have valid driver’s license and access to reliable transportation.
- Experience working in Electronic Medical Records.
- Strong communication and customer service skills.
- Ability to handle confidential information.
- Knowledge of Microsoft Systems
- Experience working in Electronic Medical Records
- Strong Organization, Communication and Customer Service skills
- Experience working in Electronic Medical Records
- Experience of Microsoft Systems
Responsibilities
- Performs eligibility services for the Florida Ryan White and AIDS Drug Assistance Program (ADAP).
- Enroll newly diagnosed and currently active HIV + clients in DOH Area 3, completing an annual enrollment for Ryan White Services and ADAP.
- Complete financial eligibility consistent with Florida HIV/AIDS Eligibility Procedure Guidelines and Ryan White Patient Care program guidelines.
- Document financial eligibilities in the FL Ryan White Patient Care Eligibility Portal, CareWare software systems, as well as HMS.
- Document ADAP in Provide Enterprise (PE) software systems and HMS.
- Verification of insurance, income, residency in accordance with DOH policy and Ryan White Eligibility manual is required.
- Conduct ADAP eligibility in accordance with ADAP eligibility manual and ensure appropriate documentation is uploaded in Provide software system.
- Upload most recent prescriptions, labs, insurance and other information as applicable in Provide software system as changes occur.
- Interviews pregnant women to determine eligibility for presumptive Medicaid benefits using manual procedures and a computerized Florida System.
- Assess clients for psycho-social needs such as Food stamps, housing, transportation, legal, mental health and substance abuse and refer as appropriate.
- Establishes liaisons with economic services staff to facilitate referrals, track dispositions, and assist clients in complying with the Medicaid application process.
- Serve as back up for Area 3 Staff and travel throughout Area 3/13 as needed.
- Ensures eligibility and clinical data is entered timely and accurately following program guidelines.
- Enters viral loads and CD4 counts every 4-6 months into PE module to ensure viral suppression.
- Participates in ADAP monthly telephone conference calls.
- Maintain knowledge of Medicare Part C & D programs, Affordable Care Act and private insurance programs.
- Maintain an understanding of adequate coverage based on ADAP standards, insurance terminology as well as an understanding labs.
- Reviews applications for completeness and accuracy; advocating on behalf of clients with health insurance plan representatives, accountable care organizations, Medicare, Medicaid, The Centers for Medicare and Medicaid Services (CMS), and the Federal Insurance Marketplace; and disputes with health plans and other benefit programs.
- Processes disenrollments.
- Maintains expertise and knowledge in other benefit programs, including Medicare, Medicaid, SSI, SSDI, and other federal and state categorical assistance programs.
- Conveys information to case managers, field staff and medical providers.
- Collaborate with community-based organizations and pharmacy personnel to ensure continuity of care.
- Complete EARS Weekly; attend and participate in staff meetings and trainings.
- Performs all other related duties as requested.
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;
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
