Patient Services Specialist II

Job Description

Job Description

Position: #700325

Department: Health Services

Reports to: Senior Manager of Benefits and Enrollment

Shift Differential Premium: $1.75 per hour for hours worked between 6pm-6am

Schedule: Monday-Thursday 10:00am – 7:00pm, Friday 8:30am-5:30pm

Status: 100%, Full-Time, Non-Exempt, Union

Probation: 90 days

Benefits: Medical, Dental, Vision; also including Life Insurance, Long-Term Disability, Employee Assistance Program, and a 403(b) Retirement Plan

Center’s Mission:

Building a world where LGBT people thrive as healthy, equal, and complete members of society.

DEPARTMENT SUMMARY: As the nation’s largest and most experienced provider of LGBT medical and mental health services, we help LGBTQ people lead healthier, happier lives, by keeping their minds and body well. All services are free or low cost. We’re also one of the few Federally Qualified Health Centers in the nation with providers who specialize in primary care for LGBTQ people and with a research team working to advance the care and treatment of people in our community.

JOB SUMMARY: Under the direction of the Senior Manager of Benefits and Enrollment, the Patient Services Specialist II will be responsible for providing direct enrollment, navigation and linkage into insurance programs, social services benefits, and Center programs. They are also responsible for ensuring patients retain insurance and care as they move seamlessly between insurance/benefits plans. 

ESSENTIAL FUNCTIONS: 

• Assist and directly enroll new and established patients in person, by phone, text, and/or email into payers including but not limited to Medi-Cal, Covered California, ADAP, Ryan White, MHLA, OA-HIPP, EB-HIPP, and PrEP AP.

• Assess/review patients’ eligibility for private and/or public insurance coverage using technology platforms.

• Create and monitor client caseload reports to ensure established patients are not falling out of care due to loss of insurance.

• Provide information to clients via telephone, in-person and through technology platforms regarding the Medi-Cal, Covered California, ADAP, Ryan White and other payers.

• Perform outreach to patients who have lost insurance coverage, particularly Medi-Cal, to re-establish eligibility.

• Assist with out-of-pocket claim filing for medical care that meet ADAP guidelines as needed.

• Review patient documentation for completeness and accuracy to ensure program enrollment meets guidelines.

• Ensure patient information is entered correctly into data systems including Covered California, BenefitsCal, One E-App, Casewatch, EHR, Practice Management system, and the ADAP portal.

• Use patient population health management reporting tools (ex., i2i and Phreesia) to build data queries to identify and reach out to patients who have insurance expiration dates approaching.

• Maintain and upload documentation for the Medi-Cal, Covered California, MHLA, BenefitsCal, One E-App, ADAP and Ryan White programs consistent with program requirements.

• Interface with the pharmacy staff to ensure patients stay engaged in care through benefits enrollment.

• Educates and provides information to clients about services available throughout the Center and externally in Los Angeles County and assists in program enrollment relevant to their individual needs.

• Schedules medical visits and other services such as mental health, 12-step programs, legal aid, housing assistance, general relief, and support services as needed in all locations.

• Assesses for and helps mitigate barriers to care by directly enrolling people into appropriate insurance and benefits programs.

• (listed above) including programs within BenefitsCal (CalFresh and General Relief).

• Provides consistent collaboration and follow-through within the Department, with other relevant Center programs and externally to identify possible patients and establish or re-establish care and increase retention in existing Center programs.

• Coordinates with clinical staff including Health Services nursing and psychosocial case management to ensure continuity of care following patient’s attendance of medical visits.

• Enters and maintains accurate data collection, enrollment, tracking, and reporting.

• Attend weekly staff meetings and other meetings as needed.

• Other duties as assigned.

JOB QUALIFICATIONS AND EXPERIENCE: 

• Experience working with the LGBTQ community and familiarity with issues of particular relevance to LGBTQ people.

• A passion for the Center’s work and its mission to make the world a better place for LGBTQ people.

• Minimum 3 years of experience in finance, economics, accounting, or related field (education in finance, economics, accounting, or related field may be substituted for experience).

• Minimum 2 years of experience in working in an outpatient clinical setting, preferably as a direct enroller into benefits programs.

• Knowledge of medical care including HIV care/service providers and organizations.

• Computer skills and knowledge including word processing, database operations, and spreadsheets.

• Advanced knowledge regarding public benefits programs (Medi-Cal, BenefitsCal, Medicare, Ryan White, MHLA, ADAP, SSI, etc.).

• Excellent verbal and written communication skills.

• Must currently be a Covered California certified enroller or pass Covered California certification exam within 90 days in position and maintain that certification to stay in position.

• Bilingual skills, a plus (English/Spanish fluency preferred).

• Demonstrated ability to work effectively with people of diverse races, ethnicities, nationalities, sexual orientations, gender identities, gender expression, socio-economic backgrounds, religions, ages, English-speaking abilities, immigration status, and physical abilities in a multicultural environment.

The Los Angeles LGBT Center is an Equal Opportunity Employer and is committed to fostering diversity within its staff. Applications are encouraged from all persons regardless of their race, color, ancestry, religious creed, national origin, sex, sexual orientation, gender identity, gender expression, medical/physical/mental condition, pregnancy/childbirth and related medical condition, age, marital status, or veteran status.