Benefit Enrollment Specialist

JOB SUMMARY
The Benefit Enrollment Specialist works with insured and uninsured members to support access to clinical services, HIV/AIDS medications, insurance coverage, and financial assistance with insurance premiums. The Specialist may assist members with State Department of Public Health
(DPH), ADAP (AIDS Drug Assistance Program), HICP (Health Insurance Continuation Program), and Affordable Care Act (ACA) health coverage applications through Georgia Access.

The Specialist is responsible for collecting and submitting required documentation, coordinating enrollment and recertification activities, and maintaining accurate insurance information. As a Certified Application Counselor (CAC), the Specialist also provides unbiased application and
enrollment assistance through Georgia Access, with the majority of ACA enrollment activity occurring during the annual Open Enrollment period.

ESSENTIAL DUTIES & RESPONSIBILITIES
o Provide Medication and insurance assistance services to members
o Determine if members are eligible for HICP/ADAP according to DPH Guidelines and Policies and conduct intakes for eligible members
o Collect insurance, demographics, and eligibility information in a timely and accurate manner
o Communicate financial policies to members
o Completely and accurately enter member's demographic information, eligibility documents, and required documents including authorization forms into appropriate electronic systems
o Routinely verify and update insurance/eligibility information into appropriate electronic systems
o Complete HICP/ADAP applications on behalf of eligible members to submit to DPH
o Obtain and maintain Georgia Access Certification as a Certified Application Counselor (CAC) within 30 days of hire or assignment to CAC duties, including completion of all required training and examinations.
o Provide unbiased assistance to members applying for, renewing, or enrolling in ACA health coverage through Georgia Access
o Assist members with comparing available coverage options without recommending, selling, soliciting, negotiating, or providing specific health plan advice.
o Provide increased ACA application and enrollment assistance during the annual Open Enrollment period and support Special Enrollment Period applications, as applicable.
o Provide updated information received from DPH to AID Atlanta employees associated with changes in DPH Guidelines for completing and processing applications
o Follow up w/ DPH on the status of all applications and report outcome to members in a timely
manner
o If approved by DPH, Benefit Enrollment Specialist will notify (letters, phone calls, emails, etc.) member of scheduled date to recertify for continuation of services 6 to 8 weeks prior to their annual recertification date
o Educate members about medication and insurance assistance, agency policies, and other agency programs to ensure members have clear expectations of services
o Perform clerical duties such as filing, answering / returning phone calls, writing and sending correspondence through letters, emails, etc.
o Document into e2AA/e2F all interactions with or on behalf of a member within 72 hours
o Complete monthly reporting and update Member Tracking Form to ensure accurate and programmatic reporting (based on position/site assigned)
o Notify DPH of changes in status to include but not limited to program ineligibility and changes in information needed to process payments and transfer of case
o Serve as a liaison between various entities to collect required documents to prove eligibility and facilitate the application process
o Make internal and external referrals to assist members with their needs beyond the scope of the Benefit Enrollment Specialist services and/or AID Atlanta services (i.e. medical clinics, insurance companies, pharmacies, etc.)
o Serve as a consultant for case managers & other staff when completing HICP / ADAP applications
o Offer suggestions, advice and recommendations and information to members who are seeking insurance / medication assistance (including, but not limited to, referrals to ADAP / HICP programs, seeking a conversion policy, pharmaceutical companies Patience Assistance Programs (PAPs), co- pay / deductible pay assistance, etc.)
o Conduct presentations/information sessions about AID Atlanta services related to the Benefit Enrollment Specialist position
o Mediate between multiple agencies to resolve member complaints & concerns in order to prevent or minimize gaps in services
o Assist members with finding opportunities and creative ways to access meds or financial assistance for making premium payments during interims of no assistance through HICP/ADAP.
o Complete MAF (Member Assistance Funds) application in order to aide members with premium and co-pay assistance to prevent lapses in coverage and ensure adherence
o Serve as an intermediary between DPH, members, staff members, case managers, insurance companies, pharmaceutical companies, pharmacies, doctors, nurses, and other professional entities associated with ADAP / HICP programs
o Attend agency, local, state and national meetings, conferences, or workshops as needed or required.
o Participate in various mandatory trainings held internally and externally ensuring a continuous knowledge base of programs that benefit members
o Adhere to policies and procedures for AID Atlanta and other off-site programs to ensure quality standards are met
o Abide by NASW code of ethics, HIPAA, Bill of Rights, and Atlanta EMA Case Management Standards to ensure a high level of professionalism is maintained.
o Address member concerns utilizing the Customer Service Standards.
o Perform routine self-audits and maintain charts to ensure member information and eligibility documents are current

SUPERVISORY RESPONSIBILITIES:
o None

QUALIFICATIONS:
EDUCATION & WORK EXPERIENCE
o High School Diploma
o 2+ years of relevant work experience
o Ability to learn quickly
o EMR experience preferred
o Experience with & understanding of insurance and prescription programs
o Ability to obtain and maintain all required Georgia Access Certification as a Certified Application Counselor training, and annual recertification.
o Must pass criminal background check

Join the Team – Make A Difference! Work at AID Atlanta, an affiliate of AHF.

AID Atlanta, Inc. has been saving and transforming lives since its inception in 1982. The agency is the Southeast’s oldest, largest, and most comprehensive AIDS Service Organization.

Today, AID Atlanta offers a broad range of services and has grown to be the most comprehensive AIDS service organization in the Southeast.  AID Atlanta currently offers HIV/AIDS prevention and care services, including (but not limited to) Primary Care, HIV/STD Screening, PrEP, Community HIV Prevention Programs, Linkage Services, Case Management, and a state-wide Information Hotline.

The mission of AID Atlanta is to reduce new HIV infections and improve the quality of life of its clients by breaking barriers and building community.

AID Atlanta’s core values:

• Respect
• Compassion
• Service
• Integrity

If you would like to be a part of fostering empowerment in someone’s life, AID Atlanta is the place for you.

Required:

Bachelor’s Degree in Human Services, Psychology, Sociology or Social Work related field and 1-2 years’ experience in the field of social work/case management or similar field.