Benefit Enrollment Specialist

Job Summary The Benefit Enrollment Specialist works with insured and uninsured members to support access to clinical services, HIV/AIDS medications, insurance coverage, and financial assistance with insurance premiums. The Specialist may assist members with State Department of Public Health (DPH), ADAP (AIDS Drug Assistance Program), HICP (Health Insurance Continuation Program), and Affordable Care Act (ACA) health coverage applications through Georgia Access. The Specialist is responsible for collecting and submitting required documentation, coordinating enrollment and recertification activities, and maintaining accurate insurance information. As a Certified Application Counselor (CAC), the Specialist also provides unbiased application and enrollment assistance through Georgia Access, with the majority of ACA enrollment activity occurring during the annual Open Enrollment period. Essential Duties & Responsibilities Provide Medication and insurance assistance services to membersDetermine if members are eligible for HICP/ADAP according to DPH Guidelines and Policies and conduct intakes for eligible membersCollect insurance, demographics, and eligibility information in a timely and accurate mannerCommunicate financial policies to membersCompletely and accurately enter member's demographic information, eligibility documents, and required documents including authorization forms into appropriate electronic systemsRoutinely verify and update insurance/eligibility information into appropriate electronic systemsComplete HICP/ADAP applications on behalf of eligible members to submit to DPHObtain and maintain Georgia Access Certification as a Certified Application Counselor (CAC) within 30 days of hire or assignment to CAC duties, including completion of all required training and examinations.Provide unbiased assistance to members applying for, renewing, or enrolling in ACA health coverage through Georgia AccessAssist members with comparing available coverage options without recommending, selling, soliciting, negotiating, or providing specific health plan advice.Provide increased ACA application and enrollment assistance during the annual Open Enrollment period and support Special Enrollment Period applications, as applicable.Provide updated information received from DPH to AID Atlanta employees associated with changes in DPH Guidelines for completing and processing applicationsFollow up w/ DPH on the status of all applications and report outcome to members in a timely manner If approved by DPH, Benefit Enrollment Specialist will notify (letters, phone calls, emails, etc.) member of scheduled date to recertify for continuation of services 6 to 8 weeks prior to their annual recertification dateEducate members about medication and insurance assistance, agency policies, and other agency programs to ensure members have clear expectations of servicesPerform clerical duties such as filing, answering / returning phone calls, writing and sending correspondence through letters, emails, etc.Document into e2AA/e2F all interactions with or on behalf of a member within 72 hoursComplete monthly reporting and update Member Tracking Form to ensure accurate and programmatic reporting (based on position/site assigned)Notify DPH of changes in status to include but not limited to program ineligibility and changes in information needed to process payments and transfer of caseServe as a liaison between various entities to collect required documents to prove eligibility and facilitate the application processMake internal and external referrals to assist members with their needs beyond the scope of the Benefit Enrollment Specialist services and/or AID Atlanta services (i.e. medical clinics, insurance companies, pharmacies, etc.)Serve as a consultant for case managers & other staff when completing HICP / ADAP applicationsOffer suggestions, advice and recommendations and information to members who are seeking insurance / medication assistance (including, but not limited to, referrals to ADAP / HICP programs, seeking a conversion policy, pharmaceutical companies Patience Assistance Programs (PAPs), co- pay / deductible pay assistance, etc.)Conduct presentations/information sessions about AID Atlanta services related to the Benefit Enrollment Specialist positionMediate between multiple agencies to resolve member complaints & concerns in order to prevent or minimize gaps in servicesAssist members with finding opportunities and creative ways to access meds or financial assistance for making premium payments during interims of no assistance through HICP/ADAP.Complete MAF (Member Assistance Funds) application in order to aide members with premium and co-pay assistance to prevent lapses in coverage and ensure adherenceServe as an intermediary between DPH, members, staff members, case managers, insurance companies, pharmaceutical companies, pharmacies, doctors, nurses, and other professional entities associated with ADAP / HICP programsAttend agency, local, state and national meetings, conferences, or workshops as needed or required.Participate in various mandatory trainings held internally and externally ensuring a continuous knowledge base of programs that benefit membersAdhere to policies and procedures for AID Atlanta and other off-site programs to ensure quality standards are metAbide by NASW code of ethics, HIPAA, Bill of Rights, and Atlanta EMA Case Management Standards to ensure a high level of professionalism is maintained.Address member concerns utilizing the Customer Service Standards.Perform routine self-audits and maintain charts to ensure member information and eligibility documents are current Supervisory Responsibilities None Qualifications EDUCATION & WORK EXPERIENCE High School Diploma2+ years of relevant work experienceAbility to learn quicklyEMR experience preferredExperience with & understanding of insurance and prescription programsAbility to obtain and maintain all required Georgia Access Certification as a Certified Application Counselor training, and annual recertification.Must pass criminal background check