Entitlement Manager

Position Summary

The Entitlement Manager provides oversight and supervision of BHAP, DC Health Link, Prince George’s County Health Connect program and Montgomery County. The Manager is responsible for supporting the adherence of all program requirements for DC and Maryland residents in the Medicaid, Alliance, Private insurance and/or entitlement programs. This role also supports the Affordable Care Act programing for DC and Maryland. The position ensures adherence with all protocols and best practices as determined by the contractors, funders, and regulations. Under the supervision of the Director of Patient Administrative Services, the Entitlement Manager ensures qualified staff are trained in accordance with the requirements of the role, monitors the performance of all staff and supports the writing of all reports for the project. This position supports communication and advocacy efforts on behalf of the program and communities served.

Reportability

This position will report directly to the Director of Patient Administrative Services. This position will manage/supervise a team of three supervisors and three different programs.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Management

• Provide supervision to staff that work directly with participants to screen for insurance eligibility. Meets regularly with staff, at minimum biweekly, to review performance of previous week, ability to reach targeted objectives, document identified electronic systems and trouble shoot any areas of concern.
• Ensure coverage at Mary’s Center and other locations as identified.
• With the support of the Director ensures smooth operations of District, Prince George’s County, and Montgomery County available safety net insurances to include, Medicaid, Alliance and other entitlements as identified enrollment processes.
• Evaluate staff performance annually and as indicated to ensure staff receive the resources necessary to be effective and provide corrective actions as needed.
• When necessary, work with the Director of Patient Administrative Services and VP of Operations to develop Memoranda of Understanding with partnering agency(ies) with which we may provide BHAP or insurance enrollment activities.
• Assemble all necessary documentation and data for reports.
• Provide both quantitative data as well as narrative reports to funders.
• Attend all necessary meetings, helps to schedule staff to participate in necessary outreach and/or enrollment events.
• Monitor supply needs of staff and support staff in having those items necessary for their role.
• Strengthen partnerships with community resources in DC, Prince George’s County and Montgomery County.

Health Insurance Screening

When necessary, provides coverage and support related to Insurance Screening to include:

• Screen participants for public benefits, counseling participants on the range of benefits for which they may be eligible, and assisting in the completion of new medical assistance applications.
• Track the status of pending applications, advocating for participants with government offices as necessary, and identifying matters that should be referred to social services for further action and advocacy.
• Build and maintain successful working relationships with appropriate public benefit and community-based agencies in the District and Maryland, including the DHS as well as PG County Social Services Department, DC Health Link and Montgomery County.
• Work directly with MCO representatives to resolve any participant insurance issues, such as changing plans or assigning a PCP.

General

• Provide and model outstanding customer service to our participants and the public.

Qualifications

The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills & Abilities –

• Strong supervisory experience, experience working in a fast-paced setting, and able to operate independently.
• Experience in a medical setting preferred, working directly with clients, knowledge of public benefits programs and eligibility standards in the District and Maryland.
• Must have a thorough understanding and working knowledge of patient confidentiality protocols and HIPAA compliance/regulations.

Language Requirement – Must be fluent in English/ Spanish/ or English/Amharic.

Physical Demands – Regularly required to sit; frequently required to reach with hands and arms, walk, stoop, kneel, crouch, talk or hear; must be able to lift objects up to twenty-five (25) pounds.

Work Environment –Mostly in a typical office or clinic setting with a quiet to moderate noise level. May be exposed to extreme cold, heat, and humidity due to outside weather conditions. Work a hybrid schedule – remotely & onsite, as needed.

The Benefits:

• Health Insurance: medical, dental & vision – plus retirement options through 403(b) contribution and investment opportunities
• 25 days of paid leave annually (in addition to paid holidays), plus 5 educational days
• Tuition reimbursement of $2,000/year towards education assistance and professional development. Reimbursement is pro-rated based on the employee's regularly scheduled hours worked per week
• Transportation subsidy via metro & bus
• Employee Assistance Program (EAP)