Takes direction from the Entitlement Services supervisory/management staff in the carrying out of assignments that include the processing, maintenance and completion of the following Entitlements Claims Specialist job tasks and responsibilities:
MAINTAIN ENTITLEMENT CASE RECORDS:
Maintains Entitlement client case records in a timely and accurate manner – the up-to-date filing of all incoming entitlement correspondence, inter- and intra-agency documents and information documents relating to the resident’s entitlement case.
Maintains an up-to-date and accurate written record, in the Contact Notes section of the client case record, of all Entitlement interactions with residents, and with all the entitlement systems, and inter- and intra-agency contacts pertaining to the resident’s entitlement cas
Utilizes the Entitlement case record as an analytical tool to be able to efficiently access entitlement information when problems arise and for other purposes, e.g., statistical surveys, departmental reports, etc., and is able to use this resource to problem solve and to present this information for supervisory review.
Archives hardcopy files in compliance with records retention policies.
Maintains any and all additional ICL Entitlement forms and procedures that may be developed to enhance the full range of maintenance of case records task.
MAINTAIN THE MONTHLY MEDICAID APPLICATIONS & RECERTIFCATION PROCEDURE TO ENSURE THAT THE MEMBERS MEDICAID IS ACTIVE OR IN THE PENDING PROCESS OF BECOMING ACTIVE
Monitor Medicaid end date reports to ensure that the member is aware that their Medicaid is due for recertification.
Support the member and the Care Coordinator with educational resources, escorts to SSA office and/or the on-line SSA portal application efforts to apply for Medicaid recertification.
Provides technical assistance to consumers and their case managers and maintains the necessary financial records and required procedures to ensure that all Surplus Medicaid
Task 4 :
Utilize all indirect billing systems to closely monitor any Medicaid coverage issues that would negatively impact billing claims being submitted as a clean claim.
MAINTAINS AND UPDATES THE LATEST IN ENTITLEMENT BENEFITS AND PROCEDURES THROUGH THE USE OF THE INTERNET AND OTHER RESEARCH TOOLS:
Task 1: The Specialist is fluent in the use of the major entitlement benefit web sites in order to access and research specific entitlement benefits information.
Task 2: The Specialist is familiar with and able to readily use The Public Benefits Research Center (PBRC) Manual as a research tool in order to access New York State entitlement benefits and location information in the ongoing management of his or her consumer cases.
Task 3: The Specialist is able to utilize and integrate any new entitlements information accessed through the use of electronic and other media (such as: PDR - the Physician’s Desk Reference, POMS – the collection of SSA rules and regulations, HRA Policy Directives), in his or her ongoing case management activities.
Task 4: The Specialist is able to utilize any type of resources in order to prepare presentations for consumers and clinical staff.
MAINTAINS DAILY CLOSE INTERDEPARTMENTAL RELATIONSHIP WITH THE VARIOUS ICL DEPARTMENTS AND IS ABLE TO FULLY UNDERSTAND AND PROCESS THE FINANCE REPORTS AND THE ADDITIOANAL FORMS AND PAPERWORK THAT ARE REGULARLY ISSUED:
Task 1: The Specialist is able to read and understand the following regularly ICL - issued reports and is able to integrate the reported information into his or her ongoing case management activities:
Task 2: The Specialist is able to analyze Finance reports, research individual consumer’s information, and determine further actions.
Task 3: Maintains an on-going contacts with other ICL Departments such as: Central Access, Corporate Compliance, Quality Assurance, programs staff, clinical managers and doctors to maintain accurate and up-to-date clients’ case management activities.
DEVELOPS AND MAINTAINS COLLATERAL CONTACTS:
Task 1: Accesses, develops and maintains collateral agency contacts and relationships in order to better receive and process entitlement information and documents so as to maximize the resident’s entitlement benefits.
Task 2: Utilizes these collateral agency contacts as an on-going resource for additional entitlement knowledge and as a means of expanding and enhancing the Coordinator’s advocacy skills.
Task 3: Communicates in an effective manner, both orally and in writing, with wide range of collateral agencies to initiate, maximize and continue the resident’s entitlement benefits and services. Be able to effectively communicate with the highest level of collateral staffs such as: AA to the Director, Supervisor or Manager to ensure the clients’ benefits cases are processed timely and in an efficient manner.
Task 4: Serve as a client advocate in front of SSA court and at PA, Medicaid and Food Stamps Fair Hearings. Collect and process all medical documentation and forms used to help ICL consumers during their Hearings.
Task 5: Maintains any and all additional ICL Entitlement forms and procedures that may be developed to enhance these collateral contact tasks.
PROVIDES ENTITLEMENT COUNSELLING TO MANAGEMENT & DIRECT CARE STAFF:
Task 1: Maintains regularly scheduled Entitlement counseling periods and meetings for the purpose of providing entitlement outreach and advisement to both residents and staff.
Specialist should be able to provide individualized benefits advisement services to consumers, which includes collecting the data, analysis and a recommendation to the individual.
Task 2: Is able to communicate effectively and sensitively with both residents and staff and is particularly attuned to the resident’s varied and changing abilities to process the often difficult and complex entitlement information.
Task 3: Serves as a dependable and accurate resource of entitlement information for ICL Management and direct-care clinical staffs.
Provide training and on-going technical support to clinical management staff with the new and complicated benefit program: Medicare Part D.
Task 4: Maintains any and all additional ICL Entitlement forms and procedures that may be developed to enhance these counseling and reporting tasks.
ATTENDS ALL SCHEDULED ENTITLEMENT SUPERVISORY AND BENEFITS TRAININGS:
Task 1: Actively participates in the supervisory process and is able to utilize supervision by
taking direction regarding the daily processing and completion of assigned departmental
tasks and in order to enhance and expand the specialist’s entitlement knowledge base
and the skills necessary to effectively work with residents, agency staffs and the various benefit
systems that fund the agency’s resident-clients.
Task 2: Attends various benefits training sessions, be able to understand and comprehend the ever changing Entitlements operation procedures, relay the subsequent information to the co- workers and utilize it in Specialist’ day-to-day work.
QUANTITY AND QUALITY OF WORK STANDARD:
In regard to all the tasks described above, it is recognized that the pressure of work can often be very intense and that it is often impossible for a counselor’s work to be completed by the end of the usual workday. Nonetheless, it will be expected that the Entitlements Claims Specialist, after a certain time and experience on the job (approximately after the initial six to eight months), will be able to make reasonable judgments as to which work tasks should be completed sooner rather than later. In other words, the counselor should be able, at this point, to prioritize their range of tasks. The counselor should be able, therefore, to organize a paperwork and case management triage system and process for themselves that will not jeopardize either a resident’s entitlement benefits or the entitlement revenue returns to the agency.
Bachelor’s degree (B.A.) plus 2 years experience in social/human services (providing services to individuals with psychiatric disabilities a plus), entitlement or related area of service, or
Associate degree plus 4 years of above experience, or
High School diploma/G.E.D. plus 5 years of above experience.
Must demonstrate excellent verbal and written communication skills along with developed computer literacy and excellent organizational skills.