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JOB SUMMARY
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Under the supervision of a higher classified employee, functions as a member of the clinical team that provides assistance and coordination of a range of consumer related financial/medication responsibilities.
This includes, but is not limited to: insurance/benefit acquisition and maintenance, medication coverage and benefit and financial troubleshooting. The employee will be working in the youth and family program assisting and supporting respite and children's specialty services.
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EXAMPLES OF DUTIES
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Essential Duties:
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Assist with budget development
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Assist with the research and purchase of adaptive equipment
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Monitor authorizations and individual plan of service
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Client Financial Review Process
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Reviews existing insurance and follows up to maintaining coverage.
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Troubleshooting insurance application process and interruptions.
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Informs consumers of appeal process for financial determination, and consults on appeal process for Local Dispute Coordinator as needed.
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For indigent or underinsured consumers, provide basic information about available public programs and appropriate applications communicates process with CSM
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Public Insurance
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(Medicaid, Medicare, Washtenaw Health Plan, Adult Benefit Waiver)
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Reviews consumer coverage upon intake and at least at CSTS doctor appointments (3x monthly for Habilitation Waiver consumers for DD services at Ellsworth).
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Monitors Habilitation Waiver service Reports (DD services @ Ellsworth office).
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Preparing Medicaid Deductible reports daily, notifys CSM of actual date of report and date sent, gathers non-clinical costs if clinical costs alone do not meet the deductible amount. Process reports.
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Assist with insurance complications (Medicare D, Medicaid, Commercial insurance, Adult Benefit Waiver, Washtenaw Health Plan B).
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Identifies Patient Assistance Programs that individual consumers may be eligible for, completes applications and information in order to receive medication coverage (Ellsworth, Towner, Huron Valley Child Guidance Clinic).
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Commercial Insurance
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Enters authorization information into electronic medical record (as needed).
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Finds and enters insurance layers when found
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Troubleshooting insurance opportunities, reauthorizations when accepted
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Clarify specific coverage and update EMR for sub abuse, medication and mental health coverage
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1st party Payments
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Review of client financial determination process whenever new info is available (benefits, PAP, etc).
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Assists with the process of completing a new Client Financial Review (CFR)/self pay if consumer or clinician indicates that their financial circumstances have changed.
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Notifies client of ability to pay charges when created
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Indigent and Underinsured Medication Program
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Approves consumers for indigent medication coverage based on policies and guidelines.
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Communicates with clinical team if consumer¿s financial determination indicates that they do not have insurance coverage for medication
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Works with consumer and CSM to collect the necessary information to complete applications for Patient Assistance Programs, following up with consumer and team members to secure all needed information and signatures have been acquired.
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Works with medical staff, pharmacy, and pharmaceutical suppliers to track Patient Assistance Plan approvals, insure stock arrives and is appropriately credited.
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Manage refill status and ongoing maintenance of PAPs
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Assist consumer with appeal of Patient Assistance Plan denials when appropriate.
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Assists medical staff in tracking of supplies of sample medications and coordinating deliveries from pharmaceutical companies.
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Pharmacy negotiation over medication costs and timing (Medicaid Deductibles and Medicare D)
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Trouble shoots with pharmacy, medical staff and team when consumer has urgent medication needs and coverage is not in place.
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Monitoring of entitlement status of Clozaril clients.
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Enrollment of Clozaril clients in Patient Assistance Program and national database.
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Managing application process for Patient Assistance Programs.
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Monitoring consumers who have high indigent drug costs.
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Assist in resolving complicated Medicaid applications.
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Assistance in monitoring Medicaid status of Habilitation Waiver, ACT, ATO and SLECS consumers to ensure full payment of all waiver slots and minimize WCHO costs.
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Consultant to clinical staff on available programs and processes
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Benefit Counseling, Assistance, Education, and Advocacy
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Consultant to staff of available public programs for income support and health care.
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Attends training on new and changing programs; educates staff and consumers about changes.
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Provides support for annual enrollment requirements for programs such as Medicare D.
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Coordinates with other public agencies such as Washtenaw Health Plan and Department of Human Services, as needed.
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Through SSI/SSDI Outreach, Access and Recovery (SOAR), review completed SSI/SSD applications prior to submission and act as consultants for the application process.
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Assists in the monitoring, tracking, and reporting of above functions.
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Required tracking
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Patient Assistance Plan Application Log, which tracks approvals for the program, use of indigent funds, use of samples, & medication coupons.
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Tracking and communication with Patient Assistance Plans to determine status in order to identify refill, renewals and length of approval.
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Tracking of injections, verifying insurance, and identifying indigent consumers.
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The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not to be construed to be an exhaustive list of all job duties performed by personnel as classified.
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EMPLOYMENT QUALIFICATIONS
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Skills in:
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Computer skills: Microsoft Office including Excel, Access and Word, ability to use Electronic Medical Record efficiently and ability to navigate external data bases such as Medicaid, Medicare and Blue Cross & Blue Shield effectively.
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Performing mathematical calculations with speed and accuracy.
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Setting priorities, coordinating multiple projects and meeting critical deadlines.
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Using sound, independent judgment within established policy and procedural guidelines.
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Operating standard office equipment, including by not limited to, personal computer, fax machine, photocopier, and calculator.
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Performing effectively under stress; attaining precise set limits, tolerances and standards.
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Communicating effectively with the public over the phone and while servicing the clinic.
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Preparing clear and concise written correspondence.
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Ability to work effectively as a member of a team.
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Ability to work effectively with consumers with mental illness or developmental disability.
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Knowledge of:
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Services that support youth with developmental disabilities and youth with severe emotional disabilities
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Various public and commercial insurances, including Medicare, Medicaid, Washtenaw Health Plan, Blue Cross & Blue Shield, and Social Security.
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Knowledge of social systems, community mental health services and state, local and federal resources.
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Familiarity with basic insurance authorization procedures
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Strong problem solving skills.
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PHYSICAL DEMANDS
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Duties require sufficient mobility to work in a normal office setting and use standard office equipment including a computer, vision to read printed materials and a VDT screen and hearing and speech sufficient to communicate in person or over the telephone.
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EDUCATION/EXPERIENCE
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Possession of bachelor¿s degree or equivalent in social service related field. Minimum of four years experience in face-to-face interactions with persons with mental illness and/or developmental disabilities. Must have worked in a mental health related office setting, along with assisting with their health care benefits. Individuals with a four year professional degree may substitute a university level internship for the experience requirement if sufficient knowledge of public health benefits can be demonstrated.
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Computer skills including: internet communication, spreadsheets, database, and word processing. Should also demonstrate organizational skills, high productivity, and strong ability to multi-task.
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FILING DEADLINE: 11/10/09
CONTROL NUMBER: 0910-645-1734-0000
AN EQUAL OPPORTUNITY EMPLOYER
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