AHS O&E - Benefits Counselor

Equal Opportunity Employer

The mission of the Health Federation of Philadelphia is to promote community health by advancing access to high-quality, integrated, comprehensive health and human services. We believe in and are firmly committed to equal employment opportunity for employees and applicants. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion, disability, sex or gender, gender identity and/or expression, sexual orientation, military or veteran status.  This commitment applies to all aspects of the Health Federation of Philadelphia’s employment practices, including recruiting, hiring, training, and promotion.

The Outreach and Enrollment (O&E) Benefits Counselor will be knowledgeable about eligibility requirements and the benefit packages associated with health insurance coverage options, including Qualified Health Plans (QHP) through the Federal Marketplace, and other health programs such as Medicaid and CHIP. 

The Benefits Counselor will facilitate the assessment and subsequent enrollment of eligible uninsured patients and community residents.  The Benefits Counselor will provide fair, impartial, and accurate information that assists consumers with submitting health insurance applications, clarifying distinctions among QHPs, and helping qualified individuals make informed decisions during the health plan selection. The Counselor will conduct consumer assistance activities.

Counselors are expected to maintain daily logs, address action items on a daily basis, and complete and submit weekly reports on contacts, applications submitted, and outcomes. 

JOB SPECIFICATIONS

Primary Responsibilities/Duties:

• Explain the benefits and eligibility standards for relevant health insurance programs to Health Center patients and community residents.  This includes state and federal Medical Assistance (MA) programs, CHIP, and the Federally Facilitated Marketplace. The position requires knowledge of program eligibility.
• Determine appropriate insurance programs for patients/clients.
• Submit MA/CHIP enrollment forms via COMPASS and other forms to the appropriate office/agency for processing on behalf of patients/clients, ensuring inclusion of all necessary documentation. Conducting follow-up with clients and office/agency as needed.
• Work with insurance programs and staff to ensure proper and complete processing of application(s).
• Assist patients who are denied benefits with the appeal process as needed.
• Maintain accurate and complete logs, files and records of contacts, application statuses, and reasons for denial.
• Work closely with Health Center medical, nursing, and social work staff to assist patients in receipt of insurance benefits.
• Assist patients with other insurance-related tasks including HMO and PCP selections or changes, benefits questions, etc.
• Use Health Center electronic medical records to ensure thorough communication of patient’s eligibility and application status with clinical staff.
• May collaborate with PCCY, CLS and other community agencies in efforts to increase enrollment of health center patients.
• Assessments: Interview clients to determine eligibility for health insurance programs.
• Applications: Submit application on behalf of patients to appropriate health insurance programs, based on eligibility.
• As workload allows, bilingual benefits counselors will serve as an interpreter for patients at the health center.
• Must be available to work a flexible work schedule, to cover evening/Saturday events as scheduled.

Qualifications:

• Must have current certification as Certified Application Counselor (CAC) and be licensed as an Exchange Assister through the Pennsylvania Insurance Department. Current certification/licensure is preferred or must obtain CAC certification and apply for license within one (1) month of hire.
• High School Diploma required.  Some college or bachelor’s degree preferred. 
• Prior knowledge of health insurance preferred.  Experience working in public sector preferred.
• Excellent written and verbal skills.
• Skilled in using technology, including Microsoft Word and Excel.  Experience with electronic health records a plus.
• Ability to learn software quickly is preferred.
• Must have an original, current, valid and acceptable PA Child Abuse History Clearance, or obtain one within (2) months of hire.
• Must obtain CAC certification within (1) month of hire.
• Must have valid driver’s license and automobile or access to public transit as the job requires local travel (attendance at quarterly meetings, staff trainings, outreach events, etc.).

Position Type and Work Schedule:  Full-time position.  Hours 8:00am-4:00pm with a 30-minute lunch break Monday-Friday or 8:30 am-4:30pm with 30-minute lunch break Monday-Friday.  Some evening/Saturday coverage will be required for outreach events; weekday schedule will be flexible to accommodate such events.

DISCLAIMER

The Health Federation reserves the right to modify, interpret, or apply this job description in any way the Company desires. The above statements are intended to describe the general nature and level of work being performed by an employee assigned to this position. This job description in no way implies that these are the only duties, including essential duties, responsibilities and/or skills to be performed by the employee occupying this position. This job description is not an employment contract, implied, or otherwise. The employment relationship remains “at will.” The aforementioned job requirements are subject to change to reasonably accommodate qualified disabled individuals.

The Health Federation of Philadelphia (HFP) is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or preference, marital status or any classification protected by federal, state or local law.