Coverage Case Manager

  • MaineHealth
  • Portland, ME, USA
  • Mar 06, 2021

Job Description

Summary

The Coverage Case Manager is a professional, social services position that effectively manages and navigates the MaineCare and Health Insurance Marketplace application processes and enrollments on behalf of uninsured and underinsured individuals. Connecting directly with clients to identify their eligibility for coverage programs and serves as the primary advocate for clients in all stages of the enrollment or re-enrollment process. 

Responsibilities include, daily collaboration with various departments, including the Central Billing Office, to coordinate payment for care, facilitate the exchange of necessary forms and information for the client, and connect clients to other community resources as needed. Provide information about the CarePartners/MedAccess programs to callers and walk in inquiries and does initial eligibility screening via telephone and/or in person, schedules applicants for comprehensive CarePartners/MedAccess intake and enrollment services, or other health related services and referrals as needed and appropriate.

Training opportunity!!

 Become a Certified Application Counselor (CAC)

Also assists with other tasks related to enrollment, re enrollment, prescription assistance, case management, and other projects as assigned by the Program Coordinator to ensure members can access care as necessary. Provides in depth research and information for programs such as PAP, and other available community resources.

This position is located primarily at 241 Oxford St, with the potential to circulate to MMP Practices/Clinics in the Greater Portland area to meet self-pay patients in-person to assist with coverage.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

  1. Education: Successful completion of High School Degree preferred. Bachelors or Associate degree in Social Service or Healthcare field preferred.
  2. License/Certifications: N/A
  3. Experience: In-depth knowledge of state and federal agencies, community resources, and regulations acquired through no less than 2 years of experience in social/human services, health care management or related field. Experience with community outreach and networking.
  4. Demonstrates a high level of analytical skills and good judgement in assessing and planning for the varying needs of clients.
  5. Responsible for making independent decisions of a significant nature to ensure positive outcomes for clients.
  6. Interpersonal skills necessary to effectively, compassionately and cordially interact with the varying audiences, including clients, foreign language interpreters, health care providers, and billing associates.
  7. Excellent written, verbal, and listening skills to explain policies and procedures to applicants, enrollees, providers and the general public.
  8. Excellent mathematical and computation skills required to prepare reports, perform calculations, and complete forms.
  9. Superior customer service, teamwork, resource knowledge and advocacy skills.
  10. Excellent organizational skills and attention to detail.
  11. Excellent public speaking skills.
  12. Computer competency that will enable employee to operate project's software system and meet the responsibilities of the position. Proficient knowledge of Microsoft Office Products (Word, Excel, Access, Power Point) EPIC, and Internet usage.
  13. Excellent organizational skills and attention to detail.

 

Additional Information

MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org