Patient Benefits Specialist - AIDS Healthcare Foundation

Overview

Join the Team – Make A Difference! Work at AID Atlanta, an affiliate of AHF.

AID Atlanta, Inc. has been saving and transforming lives since its inception in 1982. The agency is the Southeast’s oldest, largest, and most comprehensive AIDS Service Organization.

Today, AID Atlanta offers a broad range of services and has grown to be the most comprehensive AIDS service organization in the Southeast.  AID Atlanta currently offers HIV/AIDS prevention and care services, including (but not limited to) Primary Care, HIV/STD Screening, PrEP, Community HIV Prevention Programs, Linkage Services, Case Management, and a state-wide Information Hotline.

The mission of AID Atlanta is to reduce new HIV infections and improve the quality of life of its clients by breaking barriers and building community.

AID Atlanta’s core values:

• Respect
• Compassion
• Service
• Integrity

If you would like to be a part of fostering empowerment in someone’s life, AID Atlanta is the place for you.

Responsibilities

ESSENTIAL DUTIES & RESPONSIBILITIES

• Provide Medication and insurance assistance services to clients
• Determine if clients are eligible for HICP/ADAP according to DPH Guidelines and Policies and conduct intakes for eligible clients
• Collect patient insurance, demographics, and eligibility information in a timely and accurate manner
• Communicate financial policies to patients
• Collect patient fees (co-pay, sliding scale, etc.) when applicable
• Completely and accurately enter patient insurance verification/authorization forms and demographic information into Electronic Medical Records (EMR) system prior to patient receiving services
• Enter patients authorizations for services into EMR
• Routinely verify and update patient insurance/eligibility information in the EMR
• Complete HICP/ADAP applications on behalf of eligible clients on behalf of DPH
• Provide updated information received from DPH to AID Atlanta employees associated with changes in DPH Guidelines for completing and processing applications
• Facilitate the transport of completed DPH applications to DPH via courier on a weekly basis
• Follow up w/ DPH on the status of all applications and report outcome to clients in a timely manner
• If approved by DPH, Patient Benefit Specialist will notify (letters, phone calls, emails, etc.) client of scheduled date to recertify for continuation of services 6 to 8 weeks prior to their 6 month recertification date
• Educate clients about Medication insurance assistance, and policies (Grievances, HIPAA, Member’s Rights and Responsibilities) and other agency program policies to ensure client has clear expectations of services
• Perform clerical duties such as filing, answering / returning phone calls, writing and sending correspondence through letters, emails, etc.
• Document into agency Database system all interactions with or on behalf of a client within 72 hours
• Complete monthly reporting to ensure accurate and programmatic reporting (based on position/site assigned)
• Inactivate and reactivate cases in accordance with policies and procedures updating and/or entering information in clients’ records
• 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 case. Notification
• Serve as a Liaison between various entities to collect required documents to prove eligibility and facilitate the application process
• Make referrals to outside entities to assist clients with their needs beyond the scope of AID Atlanta (physician, insurance companies, pharmacies, etc.)
• Serve as a consultant for case managers & other staff when completing / sending HICP / ADAP applications
• Provide on-going support to Case Managers and other staff related to insurance / COBRA and medication changes
• Offer suggestions, advice and recommendations and information to clients 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.)
• Make In-house referrals to various departments to address client needs beyond the scope of Patient Benefit Specialist services (CM, EDVS, EWS, Info-line, and Tax Services).
• Mediate between multiple agencies to resolve clients complaints & concerns in order to prevent or minimize gaps in services
• Assist clients 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 CAF (Client Assistance Funds) application in order to aide clients with premium and co-pay assistance to prevent lapses in coverage and ensure adherence
• Serve as an intermediary between DPH, clients, staff members, case managers, insurance companies, pharmaceutical companies, pharmacies, doctors, nurses, and other professional entities associated with ADAP / HICP programs
• Participate in and volunteer for intra and interdepartmental activities/events across the agency (i.e. AIDS Walk Fundraising, AIDS 101 participation, HIV testing and counseling, The Women’s Events, Prevent Blindness, etc.)
• Attend agency, local, state and national meetings, conferences, or workshops as needed or required.
• Adhere to policies and procedures for AID Atlanta and other off-site programs to ensure quality standards are met
• Abide by NASW code of ethics, HIPAA, Patient Bill of Rights, and Atlanta EMA Case Management Standards to ensure a high level of professionalism is maintained.
• Address client concerns utilizing the Customer Service Standards.
• Perform routine self-audits and maintain charts to ensure clients information and eligibility documents are current
• Train newly hired employees on the definition and purpose of DPH Programs, the application process and procedure as well as provide guidelines for determining eligibility
• Provide newly hired employees with information associated with common barriers to accessing medication and insurance assistance (COBRA, Conversion Policies, Pre-existing Conditions Clauses, Medicaid, Medicare, PAPs, LIS, etc.)

QUALIFICATIONS:

EDUCATION & WORK EXPERIENCE

• High School diploma
• 2+ years of relevant work experience
• Prior experience working in a medical environment a plus
• Ability to learn quickly
• EMR experience preferred
• Experience with & understanding of insurance and prescription programs
• Must pass criminal background check

Qualifications

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.