Medicaid Program Integrity Jobs in Bryan, TX (NOW HIRING)

BASIC FUNCTION

The Benefit Specialist plays a vital role with coverage and access to healthcare services by conducting comprehensive eligibility assessments to determine patients' eligibility status to allow for and facilitate access to HealthPoint healthcare programs and services.

PRIMARY RESPONSIBILITIES AND DUTIES

1. Eligibility Determination:
   1. Proactively conduct comprehensive eligibility assessments to determine patients' eligibility for HealthPoint/Federally Qualified Health Center (FQHC) programs and services.
   2. Timely review and verify patients' demographic information, income, residency, and other relevant eligibility criteria.
   3. Collaborate with patients, medical and clinical staff, other departments, and stakeholders to gather necessary documentation and information for eligibility determination.
   4. Stay updated on HealthPoint/FQHC guidelines, regulations, and program requirements to ensure accurate eligibility determinations.

1. Enrollment and Application Assistance:
   1. Assist patients in completing enrollment applications and attending eligibility determination appointments for HealthPoint/FQHC programs and other healthcare assistance programs.
   2. Provide unbiased guidance and support to patients throughout the enrollment process, ensuring accurate and timely submissions.
   3. Collaborate with internal staff and departments to ensure seamless integration of patient enrollment data into the electronic health records (EHR) system.
   4. Verify insurance and program eligibility when necessary to validate patients' healthcare coverage
   5. Maintain accurate and confidential patient records related to eligibility and enrollment activities.

1. Patient Advocacy and Education:
   1. Advocate for patients by providing information on available healthcare programs, financial assistance options, and community resources.
   2. Educate patients on their rights, responsibilities, and benefits related to HealthPoint/FQHC programs.
   3. Communicate effectively and compassionately with patients, addressing their concerns and questions regarding eligibility, enrollment, and coverage.

1. Compliance and Reporting:
   1. Adhere to all relevant HealthPoint/FQHC guidelines, regulations, and compliance requirements.
   2. Prepare and submit accurate reports, documentation, and data related to eligibility determination, enrollment activities, and program compliance.
   3. Collaborate with the compliance team to identify and address any potential compliance issues or areas for improvement.

1. Knowledge and Training:
   1. Acquire and maintain knowledge and expertise in benefit, enrollment, and program specifications of the Federal Marketplace, Your Texas Benefits, and other programs such as Medicaid and CHIP (Children s Health Insurance Program).
   2. Attend all required training to provide screening and enrollment assistance.
   3. Stay current on required training and certification programs such as the federal training to obtain consumer assistance certification.
   4. Participate in monthly conference calls and/or supplemental in-person trainings and workshops to provide updates to discuss issues, best practices, and modifications or challenges with the online application systems for Medicaid, CHIP and/or the Federal Marketplace.

1. Performs other duties as assigned
   1. Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.)

MISSION, VISION, AND VALUES

1. Empathy - Demonstrates empathy and respect for diversity in the workplace by treating all patients, guests, and colleagues with politeness and inclusivity. Open to learning from different perspectives and experiences.
2. Excellence - Maintains ethical and safety standards and shows integrity in work-related activities. Aims for excellence in job performance.
3. Enjoyment - Shows gratitude, appreciation, a commitment to learning, and professionalism by seeking feedback, accepting constructive criticism, and being open to growth and improvement in their job role.
4. Commitment to Patient/Customer Service - Exhibits good patient/customer service skills and professionalism during patient, customer, colleague interactions. Uses effective communication skills, listens to patients/customers, and responds to inquiries and concerns in a timely manner. Handles challenging situations professionally, ensuring timely resolution of problems to create positive patient/customer experiences.

CULTURE

1. Gratitude - Maintains a positive attitude and acknowledges the value of contentment and well-being in oneself and others.
2. Collaborative Team - Shows adaptability, enthusiasm, and a readiness to work with others in an inter-professional team for organizational purposes. Identifies and encourages opportunities for the professional growth of team members.
3. Quality Improvement - Works together with the team to promote ongoing improvement efforts aimed at enhancing quality standards, processes, and results.
4. Accountability - Follows regulatory guidelines and HealthPoint policies and procedures consistently. Takes responsibility for mistakes and errors when they occur.