Insurance Enrollment Specialist
- - Support Services
- Indianapolis, IN, USA
- Full Time
Insurance Enrollment Specialist
Damien Cares Team
Damien Center empowers communities and persons affected by HIV/AIDS in the state of Indiana by being a leading resource, provider, and advocate for comprehensive HIV/AIDS care, prevention, education, and related services. Damien Center, Damien Cares and Damien Pharmacy provide client-centered social services focused on care coordination, clinical and pharmacy services, mental health, housing, and nutrition to the Indianapolis community.
The Insurance Enrollment Specialist, in conjunction with other client facing team members, is responsible for helping clients enroll in and maintain active insurance and determine eligibility for other social programs including the Indiana Department of Health's HIV Medical Services Program, Marion County Public Health Department Ryan White programs, and primary insurances such as Medicare, Medicaid, Marketplace, and private insurance. The Insurance Enrollment Specialist is responsible for maintaining updated information for all HIV treatment clients and will assist in the clinic as needed for duties including but not limited to insurance verifications, billing inquiries, prior authorizations, document follow-up, data tracking, and assisting with medical staff referrals out to other organizations.
Duties and Responsibilities:
This job description describes the general nature and level of work performed by employees assigned to this position. It should not be construed as an exhaustive list of all required duties, responsibilities, and skills.
• Conduct biannual assessments with clients based on intake referral and ongoing insurance needs.
• Maintain flexible availability for scheduled client appointments, general questions, Open Enrollment periods, and urgent insurance issues.
• Assist clients with applications for Medicare, Medicaid, employer or private insurance, Marketplace, as well as state and local-level coverages with IDOH and Marion County Public Health Department, also known as the Ryan White programs.
• Analyze health plans to meet the current and future needs of clients based on client reporting and information obtained from the Care Coordinator, MCM, Linkage to Care, provider, or administrative staff.
• Review and submit all applications to the HIV Medical Services Program or similar programs, with required supporting documentation based on needs reported from the applicant's care team.
• Re-certify clients to maintain eligibility for the HIV Medical Services and Services-Only Program among similar programs, such as the Healthy Indiana Plan (HIP 2.0).
• Report changes in client status to the HIV Medical Services Program and other similar programs, including insurance carriers.
• Maintain authorized representative status and assist other staff with obtaining necessary documents to be become authorized representatives with insurance carriers and the Family and Social Services Administration (FSSA).
• Act as a liaison between client and all relevant professionals, programs, and resources.
• Return phone calls and email communication with clients within 24-48 business hours.
• Frequent communication with Care Coordinators, Medical Case Managers, and providers to ensure deadlines and client recertification responsibilities are met.
• Maintain client records and updates with necessary staff.
• Serve as the client's primary insurance contact and advocate when talking with specific providers on behalf of the client.
• Set appropriate deadlines and resolves client-reported issues in a timely manner.
• Perform special assignments and other work, on an as-needed basis.
Education and/or Experience:
Minimum three (3) years' work experience in health insurance; enrollment; or accredited college training in a related field required. Knowledge of federal, state, and local rules and regulations related to HIV Services programs and to the protection of private health information preferred. Knowledge of federal and state insurance regulations and healthcare benefits such as Medicaid, Medicare, Social Security Administration programs, COBRA, and private health insurance required. Experience in nonprofit and/or medical setting preferred.
*Work experience may substitute for education requirements on a case-by-case basis.
Knowledge, Skills, and Abilities:
Possess superior organizational and administrative skills. Excellent interpersonal and communication abilities. Excellent computer skills in a Microsoft Windows environment. Ability to work independently and achieve high standards of productivity, achieving deadlines and with superior product results. Strong calendaring, organizational, and document management skills required. Proactive approach to solving problems and communicating to leadership. Knowledge of office management systems, procedures, and office equipment required. Excellent time management skills and ability to prioritize work.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily. The requirements listed are representative of the basic knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual in this role must display the highest level of integrity and confidentiality. The individual should have effective communication skills, attention to detail and organization, and flexibility and adaptability. The individual will also maintain knowledge of trends in their area of responsibility.
The physical demands described here are general representations of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to sit, reach with hands and arms, talk, and hear. The employee frequently is required to use hands to touch and handle objects. The employee frequently stands or walks.
• The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Office setting, with sustained use of a computer.
• The noise level in the work environment is minimal to moderate.
• Maintains personal/professional competency and works to create an environment of courtesy, respect, enthusiasm, and a positive attitude in all interactions both internal and external to the organization.
• FLSA Status: Non-exempt, Hourly, Full-Time
• Benefits: Complete Benefits Package Available
• Leader: Insurance Enrollment Program Manager
Damien Center is an Equal Opportunity Employer
This position description does not constitute a contract of employment or guarantee of any terms or conditions of employment. Damien Center employees are employed on an at-will basis. Nothing in this position description restricts Damien Center's right to assign or reassign duties and responsibilities to this position at any time.