Position designed to oversee the SHIPP, Medicaid and ACA Benefits Program through the state and PointCare resources. Provides PSR staff Benefit training and education; with an emphasis on building effective patient relationships. Solving patient problems and supporting patients while they learn to self-navigate the insurance benefits system.

Assist in finding creative solutions to patient insurance barriers, be a reliable resource tor insurance information, track and report insurance out-comes.

Serves as patient insurance advocate, key liaison, and point of contact for benefit inquiries; education and application assistance for available benefits through public programs and health coverage options and affordability programs made available through the Affordable Care Act (ACA) and Senior Health Insurance Program (SHIP).

Ensures program participants are able to access the service and care needed, by ensuring documentation for enrollment into benefit programs are completed and followed up timely and appropriately.

Supports the Patient Service Representation Team for patient registration functions during times of high patient volume and unexpected service interruptions as needed and based on capacity. Takes lead in developing and presenting Medicaid Application training for all Patient Service Representatives, PIC’s and SHIPP Volunteers.

1. Convey the purposes and services of the program initiatives offered by VNA to the perspective user populations
2. Assist program participants with support in insurance management plans and goals
3. Work collaboratively and effectively within a team
4. Establish positive, supportive relationships with participants and provide weekly feedback
5. Assists clients in utilizing resources, including scheduling appointments and assisting with the completion of applications for programs for which they may be eligible
6. Assists clients in accessing health related services; including obtaining a medical home
7. Build and maintain positive working relationships with clients, providers, case managers and other representatives
8. Continuously expand knowledge and understanding of community resources, services and programs
9. Educate and train all Patient Service Representatives to assist in completing Medicaid, MPE and other public assistance programs
10. Supports the Patient Service Representation Team for patient registration during times of high patient volume and unexpected service interruptions as needed and/or based on patient capacity.
11. Strengths in cultivating new partnership opportunities and customer service
12. Competency in all functions found in the “ Patient Service Representative III”.
13. Pre-screens Health Center clients for benefit eligibility based upon income and program requirements.
14. Answers questions about public programs, health insurance, guides Illinois residents through the application process for Qualified Health Plans (offered by private insurers through the Illinois Health Insurance Marketplace), tax credits and cost sharing reductions, and assists residents in enrolling and re-enrolling in the Illinois Health Insurance Marketplace
15. Completes Medicaid, All-Kids, Family Care or Medicare applications and tracks applications through determination.
16. Verifies insurance benefits and performs outreach functions to assist clients in obtaining insurance benefits from and eligible resources.
17. Fields inquiries regarding insurance coverage and reimbursement for Health Center services. Assists in developing payment plans as necessary.
18. Explains all Health Center services, makes appointments and completes registration for Health Center services once client’s needs have been determined.
19. Conducts clinic in-reach to Health Center patients, including proactively providing information to patients on enrollment and other services available to them.
20. Assists individuals with filing appeals and exemptions.
21. Assists individuals with requesting a special enrollment period, PCP changes and insurance changes “for cause”.
22. Assists individuals in obtaining information on SHIP (Senior Health Insurance Program).
23. Handles related administrative tasks such as, inputting database information, tracking, phone calls, MEDI look ups, scanning documents, and other appropriate activities as required.
24. Participates in initial and ongoing training and program certification and recertification, as needed.
25. Meets regular enrollment benchmarks and adheres to regular reporting requirements.
26. Provides translation for clients and staff as requested and appropriate.
27. Initiates communication with supervisor to ensure an efficient use of available work time; works in assigned and designated areas.
28. Participates in meetings and is responsible for information covered at meetings if unable to attend.
29. Must follow state and federal Certified Application Counselor (CAC) guidelines and training requirements.
30. Performs face to face or call center registrations in time of high patient volumes or as directed, based on capacity.
31. Meets scheduling and registration benchmarks for quality and accuracy.
32. Follows established guidelines for use and/or disclosure of protected health information. Employees should report any breaches of the Health Insurance Portability and Accountability Act (HIPAA) rules to the Privacy Officer (Director of Quality, Education & Risk Management) immediately. Failure to comply with HIPAA policies and procedures will result in disciplinary action, up to and including termination of employment.
33. Understands and follows Health Center infection control policies.
34. Complies with all VNA policies and procedures.
35. Must follow established standards of conduct and dress code.
36. Must sign and adhere to confidentiality statement.
37. All other duties as assigned.

Compensation: Hourly Range: $20.00 - $21.87, depending on experience.

Incentives: Earn up to $500.00 quarterly based upon meeting productivity goals.

Available Employee Benefits: Medical, Dental, Vision, STD, LTD, Life Insurance, Critical Illness and Personal Accident Insurance, 403b, PTO, Tuition Reimbursement.

1. Education as developed through the attainment of AS degree or equivalent work experience in a medical office, Hospital or in a similar role.

2. CAC certification required

3. Minimum of three years’ experience in medical office preferred.and/or experience with health insurance plans, preferred.

4. Bilingual in Spanish/English as follows: Speaking – Required. Reading - Preferred. Written – Preferred.

5. Must pass all required certification and re-certification training programs.

6. Be available to work evenings and weekends.

7. Must pass background check.

8. Possesses effective organization skills.

9. Excellent computer skills and ability to navigate the internet.

10. Maintains current Illinois state driver’s license; maintains reliable transportation, maintains valid auto insurance.