County of Alameda

DESCRIPTION

Under general supervision, determines potential client eligibility for Federal, State or county health insurance programs; provides assistance to Alameda County residents with the application, enrollment and renewal processes for benefit programs and privately funded health insurance programs; provides on-going training and technical assistance to clients, clinics, contracted providers and community-based organizations regarding a variety of specialized Federal, State and County health insurance programs; participates in health program enrollment outreach events; acts as advocate/liaison on behalf of client and in conjunction with other agencies; reviews and processes provider transmittals for payment; and performs other related duties as assigned.

DISTINGUISHING FEATURES

These paraprofessional positions are located in the Health Care Services Agency and report to a Supervising Health Insurance Technician or Patient Services Supervisor. Incumbents in this position require extensive program knowledge and the ability to elicit financial information from clients’ related to various benefit and health insurance programs in possible stressful situations and convey information to medical/clinical professionals and other staff.

The Health Insurance Technician is distinguished from both the Supervising Health Insurance Technician and Patient Services Supervisor in that the two latter classes are responsible for the day-to-day supervision of Health Insurance Technicians including the coordination and delegation of work assignments, staff coverage and performance evaluations.

EXAMPLES OF DUTIES

NOTE: The following are duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual classification does not necessarily perform all duties listed.

1. Assesses the eligibility of applicants and provides enrollment and application assistance to Alameda County residents into Federal, State, County or privately funded health insurance and other benefit programs.

2. Utilizes various Federal, State and local web-based eligibility and enrollment systems to verify, complete and submit client benefit and health care insurance program applications.

3. Schedules individuals and families for enrollment appointments at local agencies, clinics and health care settings.

4. Responds to inquiries received via the County’s toll-free numbers regarding health care insurance program application and eligibility questions.

5. Participates in the design, planning and implementation of culturally and linguistically appropriate educational materials as needed.

6. Provides information to clients regarding renewal processes including the Annual eligibility Review (AER), Medi-Cal redetermination, Medicare Part D plans and annual insurance coverage benefits.

7. Plans and conducts program research and studies; prepares written and statistical reports; maintains application database to track necessary data information

8. Analyzes statistical service data related to health insurance plans and makes recommendations; conducts enrollment presentations as needed to County departments, health insurance vendors and community-based organizations.

9. Provides training to peers and contracted providers related to health care insurance system program changes, complex benefit problems, policies, procedures and services provisions.

10. Assists with the development and/or revision of written policies and procedures related to benefit and health insurance program changes as necessary to meet federal, state, and local regulations.

11. Accesses multiple data bases to review and enter client demographic and account information, insurance policy information and disbursements; monitors trust account balances, Medi-Cal eligibility records and coordination of benefits.

12. Provides ongoing training and technical assistance to County clinics, contracted providers and community-based organizations.

13. Audits health care insurance program applications for eligibility, enrollment and renewal; screen patient financial information (PFI) for determination of clients’ ability to pay, including Mental Health UMDAP liability.

14. Attends enrollment events to assist low income residents with enrollment into Federal, State, County and privately funded benefit and health care programs.

15. Assists families referred from children’s programs and school screening assessments in the processing of health insurance applications to ensure compliance with mandated guidelines and requirements

16. Acts as a client advocate in regards to; benefits denial/discontinuance; Medi-Cal, Medicare or Social Security appeals; overpayment waivers and coordination of client budget with case manager.

17. Performs other duties as required within classification.

MINIMUM QUALIFICATIONS

Experience:

The equivalent of two years full-time experience assisting clients with the application, referral and enrollment processes for federal, state or county health insurance programs, determining potential eligibility for such programs and performing health care program outreach activities in a health care or social services setting.

(Possession of an Associate of Arts Degree from an accredited college in health science, social science, or a related field may be substituted for one year of the required two years of experience.)

License:

Possession of a valid California Motor Vehicle Operator’s License.

NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination.

KNOWLEDGE AND SKILLS

NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the “Examples of Duties” section of this specification.

Knowledge of:

• Health Insurance Portability and Accountability Act (HIPAA) Personal Identifiable Information (PII) rules of patient/client confidentiality.
• Health benefit and/or application processes, regulations and procedures.
• Community organizations and resources for underserved populations.
• Community outreach techniques and methods.
• Interviewing methods and techniques.
• Administrative practices and procedures including records management and the operation of standard office equipment.
• Practices and techniques of administrative analysis.
• Report principles, research and preparation.
• Client-centered computer systems, applications and programs related to benefit plans.


Ability to:

• Plan and conduct administrative and operational research/studies.
• Prepare accurate/concise reports, correspondence, procedures and other written materials.
• Analyze and research complex benefit related problems, reach sound conclusions to develop appropriate courses of action.
• Interview clients to obtain appropriate eligibility and financial data and maintain accurate case information.
• Comprehend, interpret and follow instructions related to health insurance and benefit programs.
• Verify eligibility and/or screen for appropriate health insurance and benefit programs.
• Understand clients’ social, cultural and economic diversity related to health care.
• Advocate for clients to resolve discrepancies/inconsistencies related to client benefits and/or accounts.
• Work independently and collaboratively with multidisciplinary team, and community resources and organizations.
• Communicate clearly and effectively, both orally and in writing.
• Prioritize tasks and time in order to meet all deadlines, many under tight time constraints.
• Plan, organize and conduct presentations on health and benefit programs.
• Exercise interpersonal skills, and maintain effective working relationship with clients, families, professional, paraprofessional and support staff in the department, outside agencies and with the general public.
• Provide training to peers and community based service staff on assessing benefit eligibility and enrollment.
• Make accurate calculations and computations in regards to client’s income, assets and disbursements.

CLASS SPEC HISTORY

CC:pf 3/10/05
Newspec: 1485.doc
CSC Date: 5/11/2005
DRH:cs Revised 3/14/13
CSC Date: 05/15/13

BENEFITS

Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being.  These benefits include but are not limited to*:

For your Health & Well-Being

• Medical – HMO & PPO Plans
• Dental – HMO & PPO Plans
• Vision or Vision Reimbursement
• Share the Savings
• Basic Life Insurance 
• Supplemental Life Insurance (with optional dependent coverage for eligible employees) 
• County Allowance Credit
• Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance
• Short-Term Disability Insurance
• Long-Term Disability Insurance
• Voluntary Benefits - Accident Insurance, Critical Illness, Hospital Indemnity and Legal Services
• Employee Assistance Program

For your Financial Future

• Retirement Plan - (Defined Benefit Pension Plan)
• Deferred Compensation Plan (457 Plan or Roth Plan)

For your Work/Life Balance

• 12 paid holidays
• Floating Holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Catastrophic Sick Leave
• Pet Insurance
• Commuter Benefits Program
• Guaranteed Ride Home
• Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
• Employee Discount Program (e.g. theme parks, cell phone, etc.)
• Child Care Resources
• 1^st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.