Mercy Medical Center Clinton Insurance Agent - Consumer Assistance Specialist - Full-Time - Alternating Weekends and Rotating Holidays in South Bend, Indiana
Assists consumers and/or patients through education and distribution of fair and impartial information concerning enrollment in federal and state qualified health plans and assist in the facilitation of enrollment in federal and state qualified health plans. To ensure that patients entering designated Saint Joseph Health System facilities are educated and provided with fair, impartial and accurate information regarding federal and state qualified health plan enrollment.
Ensures customer service, quality and productivity are met. Represents the patient and/or consumer at appointments and with follow-up on all needed application/appointments. Acts as a resource for staff and patients.
- Actively demonstrates the organization’s mission and core values, and conducts oneself at all times in a
manner consistent with these values.
Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
Provides education related to state and federal qualified health plan program eligibility and/or offerings,
including the benefits of health coverage and what health coverage generally may provide.
- Provides information to patients and/or consumers that is fair, accurate and impartial whereby the patient's
and/or consumer's interests are focused upon, with the goal of assisting those individuals in understanding
their options related to health insurance.
- Facilitates the selection of a state or federal qualified health plan based upon the patient and/or consumer's
preferences, including filing all applications with appropriate state and/or federal agencies, internal
departments and ensuring timely follow through with such entities and/or departments. Such facilitation
includes proper documentation of all applications both internal and external.
- Attends seminars, meetings and training programs to remain current on issues relevant to areas of
responsibility. Reviews newsletters, bulletins, directives, legal briefs, etc. and shares information with
appropriate parties. Maintains thorough knowledge of program requirements and is familiar with all eligibility
manuals, contractual requirements, etc.
- Acts as an agent/authorized representative for the organization and on behalf of the patient at all relevant
eligibility appointments, appeals, hearings, state requested meetings, legal proceedings and/or any
- Assures accuracy of applications in the overall objective of 98% accuracy by ensuring completion and
correctness of all applications while maintaining a minimum approval rating of 80 to 85 percent for all relevant
- Provides referrals to any applicable office of health insurance consumer assistance or any appropriate State
agency for any patient and/or consumer with a grievance, complaint or question regarding their health plan,
coverage or a determination under such plan or coverage.
- Provides information in a manner that is culturally and linguistically appropriate to the needs of the population
serviced, including individuals with limited English proficiency and ensure accessibility of tools and functions
for individuals with disabilities.
- Acts as a member of the team which includes ensuring time at work is used effectively, ensuring all work is
reviewed for any errors and provides back up coverage during periods of absence.
- Performs other duties consistent with purpose of job as directed.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Education: High school graduate or equivalent required. 3-5 years equivalent experience in a business, social
services, Patient Accounting, etc. related field required. Some locations will require familiarity with Hispanic/Latino
culture as well as the ability to speak and write Spanish fluently.
Licensure: Valid Indiana driver license and proof of valid automobile insurance. Become certified and licensed as a
navigator in Indiana and Michigan within 3 months of hire. . Must acquire Indiana and Michigan, Department of
insurance, ALH License within 3 months of employment.
For Spanish speaking colleagues, must complete Certification in Medical Interpretation (e.g. Bridging the Gap) within
6 months of hire.
Experience: Prior on the job training in medical clerical skills helpful. Prior experience patient accounts, patient
access, and/or Medicaid eligibility experience required. Prior experience in insurance adjusting and private
Other Job Requirements:
Background in Medical Terminology required. Must have course completion or on-the-job training in clerical skills such as keyboarding, file management, personal computers including word processing, calendar functions, managing printers, copiers, scanner and internet search proficiency. Will be required to obtain state Medicaid Eligibility certification within the first 30 days of employment. Will be required to work various hours, days including working holidays, weekends, additional or reduced hours as determined by customer needs. Hours and schedule must accommodate the patient and/or consumer needs in order to maximize reimbursement potential for the organization.
Cannot have had the following denied, suspended or revoked: insurance agent or broker license, Indiana or Michigan Navigator certification or any other equivalent license or certification.
Cannot have been convicted of a disqualifying felony or other crime, including any unfair trade practices or fraud in the insurance business.
Must provide own transportation and be able to travel to various locations. Will be required to provide field work, which may include home visits, medical office visits, and other community-based research. This will also include skip tracing, locating and gathering of medical support for appropriate Medicaid eligibility referral. Neat, clean appearance. Hair should be clean and updated in style. Strong fragrances and excessive jewelry are prohibited. May be exposed to a variety of personalities of patients, families and visitors.
Sensitive to variations in cultural differences; seeks help from others if concerned or needs guidance. Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needs.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually.
Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $24.7 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 133,000 colleagues, including 7,800 employed physicians and clinicians.
Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org . You can also follow @TrinityHealthMI on Twitter.