Disability Advocacy Program Consultant

AmeriHealth Caritas • Southfield, MI • 2h ago

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com .

Job Summary

The Consultant champions with authority as non-attorney third-party representation, advocacy and assistance with Federal and State agencies to potentially qualified members for the purpose of obtaining Supplemental Security Income (SSI) benefits, Social Security Disability Insurance (SSDI) benefits, Medicare and Children's Special Health Care Services in Michigan.

Essential Functions:

Independently manages the CSHCS/SSI/Medicare conversion application process by working closely with member, providers, Population Health stakeholders, and local/federal agencies, including Medicaid agencies, Social Security Administration and Disability Determination Services. This includes self-directed analysis of claims data, medical records, utilization and the SSA application requirements and processes in order to advocate and champion effectively for the members. Interprets and applies application requirements to efficiently identify problems/barriers so that members may achieve a positive outcome.

Leads independent analysis of all available data related to members' claims and history, as well as applies knowledge of the Federal and State guidelines for all markets to determine individual member needs and engagement required.

Exercises authority to function as a single point of contact as the non-attorney third-party advocate for members in all Medicaid markets in the process of obtaining Federal and State benefits available to members based on their medical conditions.

Analyzes member medical history and claims documentation to interpret and apply program eligibility criteria, and collaborates with adjacent departments to better coordinate member engagement and provide single-member experience.

Maintains authority to engage with providers to facilitate the exchange of medical documentation regarding specialty treatment received for designated chronic medical conditions. Represents the enterprise to advocate for members with members, medical services, government services, providers and other stakeholders.

Leads engagement with Population Health to engage members and/or process mailings to Plan members identified as eligible for CSHCS/SSI program.

Maintains high level of procedural knowledge related to SSI, Medicare and/or CSHCS application processing and eligibility requirements.

Prepares case management files for assigned Plan members who are eligible to receive Supplemental Security.

Income (SSI), Medicare and/or CSHCS benefits and the documentation of progress toward achieving additional benefits in the CSHCS/SSI database.

Education/Experience:

Bachelor's Degree.

3 to more years managed care experience.

Other Skills:

Knowledge of medical terminology & medical records procedures.

Knowledge of referral procedures for case management, including state requirements regarding case management.

Knowledge of and experience in Children's Special Health Care Services program, medical claims processing in a Disability Determination service office or Social Security Administration office, or related experience required.

Ability to identify and utilize cultural and community resources useful.

Strong project management, analytical and problem-solving skills, and the ability to work with and through people to achieve exceptional results.

Excellent verbal, written and interpersonal skills; communication skills to facilitate conversations with internal and external parties.

Strong team player with demonstrated ability to interact effectively with all levels.

Ability to thrive in a changing environment.

Proficient in MS Office (Outlook, Word, Excel, PowerPoint, Teams).

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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