Oklahoma City, Oklahoma
Coordinator - Health Insurance Job Opening in Oklahoma City, Oklahoma - Under the supervision of the Manager, HIV Drug Assistance Program, this position is responsible for the determination of eligibility for HDAP Services including prescription co-pay and insurance premium assistance. Duties include:
Review thoroughly incoming HIV Drug Assistance applications, primarily insurance premium and prescription co-pay assistance submitted by external case managers through the program database PHIDDO; determine, based on program policy, the action to take on application within 10 working days; pend back for additional information (documenting needed action to determine eligibility), approve or deny application. This includes being able to calculate income from the income documentation provided, determining who is considered in the household income, ensuring that what is entered in the application is complete in each section and matches the provided attached documentation. Prepare and disseminate written communication materials to clients, applicants, case managers, and providers scanning and attaching all pertinent communication to client PHIDDO record(s).
Coordinate referrals and transitions to appropriate pay sources and/or benefits, including Medicare D prescription drug plans and the federal marketplace.
File appeals with insurance carriers for reinstatement of client?s insurance when policies are cancelled due to a variety of reasons.
Coordinate activities with appropriate entities including the program?s contracted pharmacy and insurance premium contractor, HDAP case managers, the state Medicaid agencies (Healthcare Authority and DHS), Oklahoma Insurance Commission, Social Security, Medicare, insurance companies, employers, and ACA navigators.
Maintain confidential client records and enrollment data.
Enter and track client information and data on specified Excel spreadsheets.
Utilize knowledge of health insurance coverage plans to review health insurance plans for the coverage the plan provides e.g. prescription coverage, and in-network, out-of-network physician status.
Coordinate, track and resolve insurance coverage and premium payment issues with the program insurance and pharmacy contractor and their systems, specific insurance plans, case managers and clients ensuring clients have health insurance coverage and appropriate timely premium payments are remitted and posted correctly.
Job Type: Temporary
Salary: $25.00 /hour
Required education:
Master's
Required license or certification:
dr
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