Benefit Eligibility Specialist Jobs in Houston, Texas

2 years previous experience working at or with an HMO or MCO organization required

A bachelor's degree may substitute for the years of required work experience

Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption

High school diploma or GED required

Manually update member eligibility data in the claims processing system using multiple sources for reference, including applications, databases, and reports

Research and resolve member eligibility issues thoroughly, timely, and accurately

2 years previous experience working at or with an HMO or MCO organization required

A bachelor's degree may substitute for the years of required work experience

Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption

High school diploma or GED required

Manually update member eligibility data in the claims processing system using multiple sources for reference, including applications, databases, and reports

Research and resolve member eligibility issues thoroughly, timely, and accurately

Desirable Knowledge, Skills, and Abilities

Sherburne County offers a comprehensive benefits package, including:

Knowledge of Federal and State structure, rules and policies governing Income Maintenance Programs.

Performs job responsibilities in a manner consistent with the County's vision, mission, and values.

Informs immediate supervisor of all-important matters pertaining to assigned job responsibilities.

The primary responsibilities for this position will be performed approximately 100% of the time indoors.

Computer Skills (CLIK) – A basic computer literacy test, assessing knowledge of internet browsers, email, chat, and word processing.

Basic Competency (CBST) – A test of basic math, verbal, and communication skills, designed to assess job readiness and trainability.

If you experience problems applying online, please call the People First Service Center at (877) 562-7287.

Benefits of Working for the State of Florida:

For a more complete list of benefits, visit www.mybenefits.myflorida.com.

Interviewing applicants to obtain and verify information needed to determine eligibility for Food Assistance, Medicaid, and Cash Assistance.

Qualifications - Education and Experience

Meet the needs of consumers, follow through, meeting deadlines, and maintain skills and knowledge to perform the job.

Apply the required knowledge and skills and exhibit critical thinking and problem solving.

Exhibit good work habits, including organizational skills, regular attendance, working independently, seeking and offering assistance when needed.

Work or volunteer experience working directly with consumers in social service type settings. Experience can be substituted for education.

Any combination of related education and relevant work experience equaling at least 4 years.

2 years previous experience working at or with an HMO or MCO organization required

A bachelor’s degree may substitute for the years of required work experience

Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption

High school diploma or GED required

Manually update member eligibility data in the claims processing system using multiple sources for reference, including applications, databases, and reports

Research and resolve member eligibility issues thoroughly, timely, and accurately

Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred

Intermediate Microsoft skills with specific experience with Excel

Obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections

Maintain quality while providing an empathetic and supportive experience to the patients, doctors, and physician offices

Previous healthcare experience with insurance or in pharmaceutical industry, preferred

Previous prior authorization and appeals experience highly desired

Handle incoming calls regarding members' prescription benefits, including copay inquiries, medication coverage, and authorization processes

Educate members on how to effectively utilize their benefits

Troubleshoot pharmacy claims in real-time, verifying information, comparing claim results to benefit rules, and entering overrides when necessary

3+ years of prior medical customer service experience

Excellent phone etiquette and typing skills (40wpm, 500kph)

Basic knowledge of Microsoft Office and internet usage

Perform managed care enrollment activities on the Welfare Management System (WMS).

Evaluate State of Health managed care issues and make next step determinations.

Review enrollment issues using WMS, eMedNY and other State Medicaid Data systems.

Interact with local district, SDOH, eMedNY and Enrollment Broker staff to resolve MC issues.

Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.

Upload scanned images into the document management system.

1+ year of Call Center Experience

Provide 2-3 professional references if requested (managers/supervisors/leadership)

Receive and screen applications, and follow-up with customers to gather any missing information.

Verify income, calculate income, determine eligibility, and process case referrals.

Index and scan returned forms.

Determines priority of eligible applicants for housing selection and coordinates applicant placement with housing managers.

Prepares and mails application for continued occupancy to residents with reasonable written notice of actions needed to complete their recertification timely;

Prepares recommendations for improvement or correction of deficient recertification activities;

Review, approve and reject applications for housing based on federal and agency regulations;

Counsels' prospective tenants on the policies and procedures relative to obtaining and maintaining a unit.

Determines residents who qualify for Earned Income Disregard (EID) exclusions;

1+ year experience in complex health insurance verification, medical billing, or patient eligibility determination

1+ year experience working in a high volume call role

Experience using salesforce.com or similar CRM tools, preferred but not required

Calling existing patients to help them change their provider to One Medical with their insurance plan.

Communicating with insurance company call center representatives to resolve issues with patient eligibility

Following communication "scripts" when handling different topics

Respond to emergency needs of clients along in collaboration with program social worker and case manager;

Experience working with special needs populations;

Strong oral and written communication skills;

Knowledge of housing law or capacity to learn;

Complete applications and eligibility determinations for consumers and/or households applying to HCS for financial and/or housing assistance;

Apply federal, state, and local regulation towards determining eligibility for housing and support services programs;

Conduct interviews by phone and in-person to gather information to assess and determine need for services and benefits.

Experience high volume of computer work, using various computer programs in a fast-paced environment.

Position Title: Benefit and Eligibility Worker (Human Services Specialist 3) – store front office

Minimum qualifications / What you need to qualify:

As a Benefit and Eligibility Worker, you will...

Managing high volume of work: Ability to complete tasks, duties, projects, and obligations with deadlines that produce high-quality results.

Experience interviewing customers in person & by phone to obtain information to determine eligibility.

Experience writing notices, reports, and narrations of eligibility determinations.

Ability to complete tasks, duties, projects, and obligations with deadlines, that produce high-quality results. Experience prioritizing a high-volume workload.

Experience daily with confidential and sensitive information.

While this position is not remote, teleworking may be approved.

We are seeking a Benefit & Eligibility Worker to join our White City Self Sufficiency team.

Knowledge, Skills & Abilities (KSAs):

Use logic, problem solving techniques, and analytical skills

Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.

A top-ranked retirement program with lifetime pension benefits

Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)

Defined benefit plan that provides for life-long income upon retirement.

Preferred Pharmacy technician or related certification

Past experience in a customer service related field

6-12 months experience as a pharmacy technician

Any and all additional eligibility requirements based on the specific position

Broad knowledge of medications, physician orders, and pharmacy systems

Excellent computer and keyboarding skills

Initiate contact with ongoing long term care recipients as required to complete their annual financial recertification.

Redetermine ongoing financial eligibility for benefits by reviewing application packets and other supplemental data as required by current policy.

Experience working in a team environment.

THIS IS WHAT YOU NEED TO QUALIFY/MINIMUM QUALIFICATIONS (MQ's):

Provide choice counseling and facilitate referrals to SHIBA, Medicare and community programs as appropriate.

Write case notes in all circumstances as required by program or policy rules.

Analytical and problem solving skills

Experience working in Microsoft Office, specifically Excel, Outlook and Word

Knowledge of Medicare, Medicaid, and third party vendors

TO APPLY PLEASE VISIT THE LINK BELOW

Applicants who do not apply using the dhsjobs link provided will NOT be considered.

For other DHS career opportunities, please visit: http://dhsjobs.dhs.ga.gov

Knowledge of Welfare Management System (WMS), Paperless Office System (POS), HRA One Viewer, and Electronic Medicaid of New York (eMedNY).

Perform quality assurance for Enterprise Data Warehouse (EDW) queries, and Welfare Management System (WMS) lookups.

Review Duplicate Client Identification Number (CIN) cases to determine which CIN should be disenrolled.

Process invalid Social Security Numbers files produced by Family Independence Administration (FIA) to assist in reducing fraud.

9:00 am to 5:00 pm

Must have knowledge of employee benefits, COBRA, and other federal/regulatory requirements

Processes benefit-related changes such as life-status changes, address changes, etc.

Resolves benefit administration service issues with internal staff and outside vendors

Counsels employees regarding benefit programs including plan features, procedures, eligibility, and premium information

2 years of related experience and/or training

Proficient PC skills (Microsoft Office, Outlook, HRIS, etc.)

Interviews applicants for veterans’ benefits making thorough investigations as to the legality and need for relief.

Performs extensive research of applicants including address (es), employment status, service dates, discharge types, dependent information, and related information.

Engages in the determination of eligibility and need of veterans and their dependents under M.G.L Chapter 115, as amended.

May conduct home visits and/or field investigations.

Coordinates the communication between caseworkers and veterans.

Keeps records on action taken on cases and submits monthly reports on all active cases.

Conduct client interviews and collect detailed information on their business and experience

Research governmental mandates and information to supplement ERC eligibility on a case-by-case basis

Research specific orders that caused disruption to client’s business operations

Analyze and interpret data gathered to guide decision making

Create reports to summarize research findings and the implications of the results

Perform compliance reviews to ensure accuracy and completeness

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

Reports any reimbursement trends/delays to management.

An equivalent combination of education and experience will be considered.

Proficient Windows-based experience including fundamentals of data entry/typing.

Reviews all patient insurance information needed to complete the benefit verification process.

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.