Dual Benefits Specialist

JOB PURPOSE AND REPORTING STRUCTURE

Under the direction of the Benefits Manager, the Dual Benefits Specialist will oversee and ensure the Outreach, Enrollment, Data Entry and completion of all Medicaid and Marketplace insurance applications, in accordance with agency policies and procedures. The Dual Benefits Specialist will also use the SOAR model and other best practices to ensure the enrollment, data entry and completion of all assigned Social Security applications as a technical resource to the Community Services Department team, in accordance with agency policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provide consumers with information and assistance to understand new health insurance options and identify the affordable coverage that best meet their needs.
• Reach out to non-ORCHC consumers in the Milwaukee Community through regular outreach to other agencies.
• Work cooperatively with the ORCHC Primary Care Clinic at 220, four ORCHC sub-contracted clinics, and community sites where the underserved populations tend to congregate.
• Utilize a single streamlined application process to determine if each consumer is eligible for Medicaid or the Affordable Insurance Marketplace. Applications can be facilitated either in the office or in the community utilizing a mobile laptop.
• Demonstrate and 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.
• Help individuals understand and access affordability options. Provide information and assistance in a fair, accurate, and impartial manner.
• Provide information and assistance in a manner that is culturally and linguistically appropriate to diverse communities and accessible to individuals with disabilities.
• Comply with and successfully complete all required and applicable federal and/or state consumer assistance training.
• Utilize a database and/or spreadsheet to track all applications/reviews and data. Document all time spent on each case. Keep copies of all applications and correspondence in charts.
• Using a holistic approach, assess all clients for other needs and refer to other ORCHC programs, as appropriate. Specific emphasis is put on the need to bring eligible clients to ORCHC.
• Maintain technical competency and remain current in technology and changes in the industry. Perform all data entry accurately into the computerized system.
• Back up to attend the Outreach and Education meetings through MKEN.
• Develop and maintain positive working relationships with clients and other employees of the agency.
• Attend all trainings and workshops scheduled as they relate specifically to this project.
• Ensure compliance with all safety and work rules and regulations. Ensure the maintenance of departmental housekeeping standards.
• Complete the SAMHSA Online SOAR Training in order to assist with Social Security applications and file for reconsiderations using the SOAR (SSI/SSDI, Outreach, Access, and Recovery) Model.
• Interpret medical records to determine the client’s diagnosis, prognosis, and duration of condition, and how that relates to the client’s ability to perform work at a level above Substantial Gainful Activity.
• Submit form 3368 (Adult Disability Report) and 16 (SSDI application) online. Provide Social Security with 827 (Release of Information), 8000 (SSI application), and 1696 (Appointment of Representative) forms.
• Maintain ongoing communication with SSA Field Office and Disability Determination Bureau.
• Collect pertinent medical evidence.
• While using the SOAR model, the benefits specialist is expected to submit a Medical Summary Report (MSR) to compliment the SSA required forms. The MSR needs to include clinical observations and diagnostic impressions that are well composed into a standard format.
• Maintain technical competency and remain current in technology and changes in the industry. Perform all data entry accurately into the computerized system.

QUALIFICATIONS

• Individual must have the ability to recognize the medical and psychiatric disabilities of claimants related to the standards established for eligibility for approval of SSI/SSDI.
• Solid writing skills, good organizational skills, and solid ability to attend to details.
• Interest in Medicaid and other public benefits.
• Solid Interpersonal skills.
• Computer knowledge

EDUCATION and/or EXPERIENCE

• Requires a Bachelor’s Degree and/or one to three years of related experience.
• Must have at least one year of experience working with individuals who have medical, physical and psychosocial conditions and be able to exhibit sensitivity to those with physical or mental disabilities as well as homelessness.

CERTIFICATES, LICENSES, REGISTRATIONS

• Requires Certified Application Counselor Certification and SOAR Certification.
• A valid driver’s license and car insurance is also required.