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- Job Purpose
This position performs a variety of functions based on the agencies' changing needs. The Patient Benefit Coordinator (PBC) team's primary duty is to establish and maintain an individual's access to relevant benefits. These duties include assisting MHMR Tarrant County individuals in obtaining SSI/SSDI benefits along with Medicaid/ Medicare and supporting through the application process. The PBC will assist with the completion of forms and preparations of medical records, as required by SSA. PBC will provide consultation and direct assistance for individuals throughout the entire SSI/SSDI application process. The PBC will help establish and maintain an individual's access to relevant benefits (SNAP, Medicaid, Medicare Open Enrollment, Cell phone), Locating and facilitating of alternate funding sources to pay for medication (Patient Assistance Program (PAP), Medicare Part D Drug Plan (PDP), Medicaid Plans, and Adjudication Control), obtaining SSI/SSDI/ SOAR benefits, and supporting the individual through the application process. Will act as a resource for benefits information to the staff and individuals we serve. Requires basic knowledge of software and data system programs.
II) Principle Responsibilities
Contact all claimant referrals and screen for SSI/SSDI disability benefit eligibility qualifications.
Schedule with claimant according to and determined by screening status.
Assist with SSI/SSDI application - Medicaid/Medicare- using SSA SSDI/online and SSI/8001 processes.
Assist with the required documentation, medical release, and medical appointments related to the disability determination process.
Follow claim and establish relationship between claimant and Medical Examiner (DDS) through the day review process.
Schedule and assist with PERKS (favorable claims); complete and return requested documentation and the complete transitional process.
If payee is required, educate and direct claimant to responsible choices.
If an Initial Denial is received, complete Reconsideration/Appeal online. Repeat steps 4-7.
If a Secondary Denial is received, assist with online filing for ALJ Hearing Appeal. Direct claimant to BCT Representation or an approved attorney list.
Return all claimant calls and follow up with claim assistant, including assistant with ADL completion.
Open and review SSA/DDS mail when required, with attention to time sensitive material.
Follow up with DDS medical record requests.
Assist with transitions into IN PAY status, especially for those in suspense status.
Provide assistance with all reduced payment situations.
Provide assistance for all payee changes and SSA 'in office' changes.
Assist, complete and file all Disability Recertifications.
Return interagency calls, and emails.
Follow claims (when possible) throughout the entire process, despite clinic transfers, home plan changes and out of County and State changes.
Complete and update BCT Spreadsheets on a weekly basis.
Collaborate with Mobile IOS Outreach teams to assist at-risk persons exhibiting or reporting behaviors suggestive of a chronic mental health disability, sexual health, homelessness or co-occurring psychiatric and substance use disorders.
Performance Requirements:
1) Screen and complete 95% of Consumer Benefits Referrals and process eligible SSI/SSDI claims on a weekly basis.
2) Complete 95% of BCT Spreadsheets on a weekly basis.
3) Complete SAL's in a timely manner according to MHMRTC policy.
Participate and contribute to Program Planning, Policy Development, and Inter-Agency Coordination of Medicaid Service Program
Attend program development meetings and performs inter-agency research projects to contribute to program planning activities.
Complete development projects as assigned by the supervisor and submits results as scheduled.
In accordance with the Random Moment in Time Study (RMTS), this staff person is officially involved in program, policy development, and inter-agency coordination of Medicaid service programs. This includes participation in regular scheduled meetings to develop strategies to increase Medicaid system capacity, focus Medicaid services on specific populations, etc.
Knowledge of Laws, Regulations, and Policies/Procedures
MHMRTC Policies and Procedures, SSI/SSDI applications, representation, and appeal procedures, Department of Assistive and Rehabilitative Services (DARS) documentation procedures, work incentive programs and procedures related to other benefits programs as provided by the supervisor.
Knowledge, Skills and Abilities
Advanced language skills (both written and verbal)
Effective interpersonal skills
Working knowledge of MHMRTC services and area resources for individuals with disabilities.
Required computer skills include data entry in approved agency computer systems, documents in Microsoft Word, and the use of e-mail.
Ability to learn new information easily and in an efficient manner.
Ability to comply with agency dress code standards.
Travel
Requires occasional overnight state-wide travel and may require ride sharing using personal and/or available company vehicle (with completed Defensive Driving course)
Requires local travel in personal vehicle between MHMR Tarrant clinics, community and social security offices as needed.
May require temporary or permanent re-assignment to any of the clinics as determined by program needs.
Equipment Used
Computer / Tablet Fax
Phone Copier
Printer Other miscellaneous office equipment
patient benefit coordinator - Fort Worth, TX , USA, United States - MHMR of Tarrant County
Description
Pay is determined by relevant experience, work history, education and internal equities. As part of our Diversity, Equity, and Inclusion practices, MHMR offers the maximum compensation for candidates based on their experience, education and internal equities of the agency. This practice removes biases in compensation and assist hires and/or promotions on pay equity in their appropriate position(s) at MHMR.
The average rate for this position is
Minimum Qualifications
Requires Bachelor's degree in Health or Human Services, Business, Finance, or related field with 2 years' experience.
Valid Texas Driver's License with proof of liability insurance
Good driving record
Excellent problem-solving skills that involve creativity in thinking outside of the box.
Special Courses, Certifications, and Licenses
- DARS Benefits Certification of Completion (Newbie Training)
- SSI/SSDI Outreach Access and Recovery (SOAR) Certification of Completion
- Texas Workforce Commission Certification (annually) (if applicable)
Personal and Public Contact
This position requires extensive contact and effective communication with applicants, family members, and representatives of other agencies, Administrative Law Judges, and health professionals. This is accomplished with advanced written and verbal skills utilized in private and public exchange of information. As a representative of MHMR Tarrant and the individuals we serve, this position requires the ability to establish and maintain positive, effective, respectful, and ethical working relationships with others at all times.
Physical/Mental Characteristics
Note: Check the physical, mental, and environmental conditions of the essential functions of the job.
Our total rewards program offers benefits* to full time employees beginning 1st of the month following hire date including but not limited to:
• Comprehensive healthcare options (Medical, Dental, and Vision)
• Life insurance and additional supplemental accident and hospitalization plans
• 401a match and 457 deferred compensation plans
• Paid vacation and holidays; varied flexible work environment locations
• Annual tuition reimbursement program
• Student Loan Forgiveness
• Professional development programs and training
• And more.....
Insurance eligibility:
• Full time employees begin 1st of the month following hire date
• Market driven positions (full time or part time) begin immediately after hire date
• Select part time market driven positions are eligible for most insurance plans
• Substitute status jobs are not eligible for benefits
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Additional Information
*MHMR of Tarrant County (MHMR) and its affiliates and subsidiaries have an internal recruiting department. MHMR may supplement that internal capability from time to time with assistance from temporary staffing agencies, placement services, and professional recruiters herein after referred to collectively as Recruiters). Recruiters are hereby specifically directed NOT to contact MHMR employees directly in an attempt to present candidates - MHMR recruiting team or other authorized MHMR personnel must present ALL candidates to hiring managers. For more information please visit our website