Medical Benefits Specialist
- Job Title
- Medical Benefits Specialist
- Chicago, IL
- Other Location
Medical Benefits Specialist
The AIDS Foundation of Chicago (AFC) mobilizes communities to create equity and justice for people living with and vulnerable to HIV or chronic conditions. We envision a world in which people living with HIV or chronic conditions will thrive, and there will be no new HIV cases. Our work focuses on advancing health equity, preventing new cases of HIV, serving as a collaboration and knowledge center, being a bold voice for change and strengthening our organizational excellence.
We are seeking for an individual to serve as our Medical Benefits Specialist. The Medical Benefit Specialist (MBS) is responsible for enrolling eligible Illinoisans receiving Ryan White services in the Cook and Collar Counties, into qualified health plans through the Illinois Health Marketplace, insurance companies, Medicaid, Medicare as well as providing assistance with ADAP benefits. The MBS will be required to complete up to 30 hours of training to obtain consumer assistance certification and will be required to recertify on an annual basis at the federal and state level. The MBS will be required to assist clients with submitting payment requests for HIV related out of pocket costs and copays related to their health insurance, as well as educate case managers and clients on how to navigate their insurance benefits.
Principal functions and responsibilities of this position include the following:
Client Benefits Enrollments
- Coordinate efforts with Ryan White-funded agencies to identify individuals to be enrolled in health insurance programs;
- Screen clients for eligibility for Medicaid, Medicare, Health Insurance Marketplace (HIM) and ADAP;
- Assist individuals in understanding HIM plans, managed care options for which they are eligible and navigating ADAP applications;
- Enroll clients in the appropriate insurance plan they select;
- Assist clients with submitting payment requests for HIV related out of pocket costs and copays;
- Respond to technical assistance requests in a timely manner using AFC’s internal ticketing system
Training Coordination and Resource Assistance
- Arrange and conduct in-reach and outreach activities, including trainings for case managers and clients regarding Marketplace, Medicaid and or CHIP (Continuous Health Insurance Plans) in Cook and Collar Regions;
- Function as a resource to case managers and consumers by providing information, assistance and referrals, and taking complaints, or grievances to any applicable office of health insurance consumer assistance or health insurance ombudsman, or any other appropriate state agency or agencies.
- Maintain knowledge and expertise by attend trainings and continuing education related to insurance programs as required by AFC including the case management competencies training;
- Demonstrate cultural competency when working with clients who may be HIV+, LGBT, homeless, indigent, substance users, mentally ill, non-English speaking, or otherwise marginalized and/or underserved;
- Ensure the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- Attend all Care Team and AFC-mandated meetings;
- Attend and assist with agency-wide events and activities as directed;
- Perform other duties as assigned.
High School Diploma and 1 plus year’s experience in Case Management and or Public Benefit Screening Experience
The ability to work non-traditional hours including evenings and weekends.
Bachelor’s degree in the Human Services field (i.e., Psychology, Sociology, Public Health, Social Work).
A basic understanding of the Affordable Care Act (ACA) and Medicaid services.
1 plus year’s experience enrolling individuals into Marketplace plans, Medicaid and/or Medicare.
Knowledge, Skills, and Abilities
Strong attention to detail and the ability to manage multiple projects, establish workload priorities, and meet deadlines are critical.
The ability to use computer and web-based systems (e.g., PC-based tools, Microsoft applications, Web-based applications) to input, access, modify, or output information or to execute programs or analysis. This includes the ability to access and store data, and to quickly enter and retrieve data from computer systems using a keyboard, mouse, or trackball.
Excellent customer service skills and strong interpersonal skills and the ability to develop and maintain professional, trusting and positive working relationships with both internal and external customers.
Also, strong verbal and written communication skills and ability to work with diverse populations are key to success in this role.
Please reference position code PROG MBS 700
Decisions and criteria governing the employment relationship with all employees at AIDS Foundation of Chicago are made in a non-discriminatory manner, without regard to race, ethnicity, creed, religion, color, sex, sexual orientation, gender identity or expression, age, national origin, citizenship status, military service and/or marital status, order of protection status, handicap, disability (including HIV/AIDS status), or any other factor determined to be unlawful by federal, state, or local statutes.