Eligibility Specialist - Access To Healthcare Network

Best Place to Work in Northern Nevada - 1st Place Winner 2024
Best Place to Work for Working Parents - 2024

Check out our AWESOME Benefits!

• 4 weeks Paid Time Off in the First Year - Front Loaded
• 14 paid holidays annually
• Hybrid Work Options Available
• 403B Retirement Plan with 4% Match
• 4 Weeks Paid Parental Leave
• Up to 4 Weeks Paid Catastrophic Leave
• Medical, Dental, and Vision benefits - effective 1st DAY OF THE MONTH, following date of hire
• Free Health Insurance Options for Full Time Employees
• Low-Cost Health Insurance Options for Dependents
• Employee Hardship Loan Program
• Free Life Insurance and Long-Term Disability
• Tuition Assistance
• Continuing Education Support
• Dog Friendly Workplace
• Child Friendly Workplace
• Great Organizational Culture!

JOB PURPOSE: The Ryan White Eligibility/Non-Medical Case Manager will help improve the health outcomes for clients living with HIV/AIDS, providing eligibility determination services, and assisting clients to obtain access to other public and private programs by enrolling into Ryan White. The Ryan White Eligibility/Non-Medical Case Manager will determine payer source for ADAP services and stay up to date with information regarding AHN programs, community partner programs, and community programs available to help our consumers improve their health and quality of life. This entails ensuring that RW members are meeting their obligations to AHN, to our providers, and to the Grantors of the program. The Eligibility/Non-Medical Case Manager will also advocate, and problem solve on behalf of our consumers to ensure that they receive a continuum of care and support. Ensuring this continuum of support requires that the Eligibility/Non-Medical Case Manager completes all funding guidelines and reporting requirements. The Eligibility/Non-Medical Case Manager will assist with scheduling appointments, maintaining spreadsheets, assisting with high call volume, as well as determining and tracking payer sources for ADAP services. The Eligibility/Non-Medical Case Manager will assist in the development and continual improvement of the Access to Healthcare Network Ryan White Program.

BASIC REQUIREMENTS:

• Bilingual (English/Spanish) preferred.
• Must have a valid driver license and be able to drive the AHN company car when needed.
• Required to pass a background check through the State of Nevada.
• Subject to Medicare and Medicaid fraud background check.
• Required to obtain a Community Health Worker Certification within the first year of employment at the agency's expense.
• Must be able to obtain an Exchange Enrollment Facilitator License (EEF) within 90 days at the agency's expense.
• Gain a clear and basic knowledge of Access to Healthcare Network administrative duties, services, and systems.
• Abide by all HIPAA requirements.
• Must attend staff meetings and be willing to meet with direct supervisor on a consistent and regular basis.

KEY RESPONSIBILITIES AND ACCOUNTABILITIES:

• Eligibility screening for potential Ryan White services to ensure clients are eligible for assistance.
• Assist clients in filling out the Ryan White application for initial certification and semi-annual recertification.
• Assist consumers in filling out the Ryan White Liberty Dental Application for enrollment for all eligible consumers.
• Learn and follow the payer of last resort rule at all times.
• Prescreen client for the HIP program to see if they qualify for any assistance (enrolling into on or off exchange, help with Health Insurance Premiums, co-pays or deductibles, tax program, etc.).
• Assist in providing EIVF to consumers and sending a referral to HIP for follow-up for obtaining this document to obtain payer of last resort proof.
• Have a working knowledge of non-AHN health care programs such as: Medicaid, Medicare, Nevada Check-Up, Prescription Drug Programs.
• Follow up with clients for missing documents preventing the completion of eligibility renewals.
• Completing the process of updating interim eligibility changes by obtaining proof of the changes, updating the application and all systems.
• Fulfill parts of the Scope of Work for the Nevada Department of Health and Clark County Nevada.
• Complete CAREWare A/B and RWISE data entry and application uploads for all eligibility applications by the end of business day.
• Complete CAREWare A/B and RWISE data entry and application uploads for all eligibility updates by the end of business day.
• Complete case management assessments, screening tool, client acuity tool and an individual service plan to assist RWPB clients with medication and treatment to achieve viral suppression.
• Assist with obtaining and entering labs into CAREWare
• Ability to manage an assigned caseload of a diverse population of People Living with HIV/AIDS.
• Respectfully interact with consumers while working cooperatively in a team environment.
• Return all phone calls, emails or written correspondence within 48 hours of receipt.
• Schedule future eligibility appointments for consumers before they leave their appointment.
• Contact consumers following grantors guidelines.
• Assist consumers in enrolling for any services available.
• Develop and maintain effective working and compassionate relationships with staff, providers, members, program partners, and program funders.
• Be able to multitask and critically think though a variety of situations.
• Gain a clear working knowledge of
• Gain a clear and basic knowledge of: CAREWare A/B, Magellan, Salesforce, and RWISE.
• Gain a clear and working knowledge of the Nevada Check-Up, Medicare, ACA and Medicaid enrollment criteria and process.
• Flexibility, each department selects the hours of work schedule for the department staff based on the department's needs. This schedule may change at any time according to the department's needs.
• Field inquiry calls from interested parties, including potential members. Explain program requirements, in both the Ryan White Part B Eligibility Program and the Ryan White Part A Eligibility Program.
• Make timely disposition of calls and take appropriate actions on inquiry calls and referrals.
• Other duties as assigned.

EDUCATION MINIMUM:

• High School Diploma required; AA Degree preferred.

EXPERIENCE MINIMUM:

• One year working in health care related social work.
• One year of general office duty experience such as: typing, filing, and faxing.
• Two years' experience working with databases and software programs such as: Microsoft Word, Excel, PowerPoint and Visio.
• Experience in medical billing and patient coordination preferred.
• Excellent organizational skills.
• Excellent communication and customer service skills.
• Must be able to lift, carry up to 30 pounds with a fair consistency.

WORK ENVIRONMENT:

• The noise level in the work environment is usually moderate and the employee usually works in a climate-controlled office environment.
• Be able to sit at a computer for 6 - 8 hours per day.
• Be able to stand between 3 - 6 hours per day.
• Be able to withstand hand/wrist deviation and repetition.

The statements herein are intended to describe the general nature and level of the position, but are not necessarily a complete list of responsibilities, duties and skills required of employee(s) so classified. As such, responsibilities, duties, and required skills may be changed, expanded, reduced, or deleted to meet the business needs of Access to Healthcare Network. Furthermore, they do not establish a contract or implied contract for employment.

As an equal opportunity employer, we are committed to identifying and developing the skills and leadership of people from diverse backgrounds. We encourage all qualified candidates to apply.