Benefits Specialist

Benefits Specialist

Under the direction of the Manager of Integrated Care, and in accordance with grant and contract requirements, the Benefits Specialist provides direct enrollment, navigation, and linkage into insurance programs, social services benefits, and Center programs. The Benefits Specialist works to ensure patients access all public benefits for which they are eligible. The Benefits Specialist guides patients, directly or through referral, through enrollment and re-enrollment in ADAP, Ryan White, OA-HIPP, Covered California, Medi-Cal, CalFresh, and General Relief, as well as other public benefits, and ensures patients retain insurance and care as they move seamlessly between insurance and benefits plans.

Essential Functions:

• Provide in-depth public benefits case management to clients seeking public benefits assistance by assisting and directly enrolling new and established patients in person, by phone, text, and/or email for all benefits including insurance, prescriptions, food and nutrition, disability, unemployment, housing, and other entitlement programs;
• Directly enroll clients into payers including but not limited to Medi-Cal, Covered California, ADAP, Ryan White, MHLA, OA-HIPP, EB-HIPP;
• Contact relevant entities, including public assistance programs, health insurance providers, social service agencies, or other institutions as needed to verify or clarify information for clients
• Assess and review patients' eligibility for private and/or public insurance coverage using technology platforms;
• Complete comprehensive benefits assessments and reassessments for each patient enrolled in the program, and assist patients in developing an appropriate individual service plan (ISP) addressing their individual needs;
• Conduct follow-up activities necessary to assist patients in the implementation and modification of their ISP;
• Create/monitor client caseload reports to ensure established patients are not falling out of care due to insurance loss;
• Provide information to clients via telephone, in person, and through technology platforms regarding 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 meets 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, e2LA, EHR, and the ADAP portal;
• Use patient population health management reporting tools to monitor 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 pharmacy staff to ensure patients stay engaged in care through benefits enrollment;
• Educate and provide information to clients about services available throughout the Center and externally in Los Angeles County, and assist in program enrollment relevant to their individual needs;
• Provide referrals for services related to medical, mental health, SUD treatment, legal support, housing assistance, and support services as needed in all locations;
• Assess for and help mitigate barriers to care by directly enrolling patients into appropriate insurance and benefits programs (listed above), including programs within BenefitsCal (CalFresh and General Relief);
• Counsel clients regarding the possible impact of work activity and employment on their public benefits;
• Provide consistent collaboration and follow-through within the Department, with other relevant Center programs, and externally to identify possible patients, establish or re-establish care, and increase retention in existing Center programs;
• Coordinate with clinical staff including Health Services nursing and psychosocial case management to ensure continuity of care;
• Enter and maintain accurate data collection, enrollment, tracking, and reporting to meet Center, grant, city, state, and federal program requirements;
• Follow agency policies and maintain agency standards with regard to client confidentiality and HIPAA compliance;
• Attend relevant trainings relating to benefits programs, and trainings required to meet grant and contract requirements;
• Collaborate with other members of the clinic team, including MCC staff, and attend weekly staff meetings and other meetings as needed;
• Other duties as assigned;

Job Qualifications and Experience:

• Knowledge of or experience working with the LGBTQ community and familiarity with issues of relevance to LGBTQ people;
• A passion for the Center's work and its mission to make the world a better place for LGBTQ people;
• 3-5 years' experience providing direct case management or other similar services (education in human services or similar field may also be accepted);
• At least two years' experience 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, DPSS, etc.);
• Excellent verbal and written communication skills;
• Must currently be a Covered California certified enroller or pass the Covered California certification exam within 90 days in position, and maintain that certification to stay in position, and this is an in-person position requiring work on site 5 days a week;
• 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, national origin, sexual orientation, gender identity and expression, sex, pregnancy, childbirth and related medical conditions, religion, disability, age, military or veteran status, including status as a victim of domestic violence, assault or stalking, genetic information (including family medical history), political affiliation or activities, medical or health conditions, and marital status.

The Center has implemented a policy requiring all staff to be up-to-date with COVID-19 vaccinations as a condition of employment, subject to applicable federal, state and local laws. For more information, please contact View email address on click.appcast.io