Overview:
At Groups, the Entitlement Specialist is a part of our Member Access Team. The Entitlement Specialist will work closely with new and ongoing members to provide assistance in accessing Medicaid, Marketplace, and Medicare insurance, SNAP, Social Security Disability, and other State and Federal entitlement benefits. This role reports to the Entitlement Supervisor.
Fully Remote work (Not available to residents of: AK, AR, CA, HI, ID, MD, NE, SD, UT, WY).
Responsibilities:
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
- Collaborate with a multidisciplinary care team to ensure the delivery of quality, member-centered care.
- Assist members in navigating and applying for Medicaid, Marketplace, and Medicare insurance along with other State and Federal entitlement benefits as needed.
- Assist members in the yearly redetermination processes for entitlement benefits.
- Assist members in collecting needed documents to apply for entitlement benefits and coordinate with social service agencies as needed.
- Become an expert on the available insurance and social service resources within assigned region.
- Work closely with the Member Financial team to communicate new insurance eligibility and follow up on inactive insurance eligibility.
- Provide cross-state coverage support as needed.
- Link members with resources as needed and follow-up with members and resources alike to ensure that all member needs were met.
- Maintain timely and accurate documentation in electronic health record.
- Participate in ongoing continuing education as required to maintain certification or licensure where required
Other Duties & Responsibilities
- Perform other duties as assigned.
Qualifications:
Knowledge, Skills and Abilities
- Fluency with office technology, including G-Suite, email, electronic medical records, and software and mobile apps (e.g., Google Apps).
- Share the Groups’ values of member-centered care and harm-reduction practices.
- Knowledge of, and ability to use motivational interviewing practices.
- Knowledge and understanding of programs, assessments, evaluations, observations and care plans.
- Ability to establish effective working relationships and maintain appropriate professional and personal boundaries with internal staff, members, and with relevant community organizations.
- Ability to maintain positive interactions with members and where appropriate professional and personal boundaries with internal staff, members, and with relevant community organizations.
- Ability to maintain confidentiality.
- Excellent written and verbal communication skills and ability to communicate complex information.
- Ability to use discretion and work independently under general supervision.
- Ability to work with diverse population of members and staff.
- Ability to understand and adhere to Professional Code of Conduct.
- Strong advocacy skills along with knowledge State and Federal benefits and eligibility guidelines.
Qualifications & Requirements
- An Associate’s degree or higher, preferably in social or human services.
- One year of experience assisting with insurance, state, and/or federal benefit applications or willingness to undergo extended training.
- One year of experience in a social service or behavioral health setting strongly preferred.
- For remote roles, access to reliable internet and telephone services, specifically 50M download and 10M upload package or higher as well as a strong WiFi signal from your remote work location.
- Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include fingerprinting, drug testing, health screening, CPR/Basic First Aid and license/credential verifications.
- You embody what Groups is all about: you care deeply about our mission; you are entrepreneurial, flexible and team-oriented; you have deep respect for the people we serve; you have unquestionable ethics.
