HRSN Coordinator

Job Description

Job Description

The HRSN Coordinator provides support to HRSN Team. Screens, navigates, and processes community members request to eligible 1115 waiver services. Ensuring accurate information is collected and entered into Unite Us and any necessary databases utilized for the delivery of 1115 services, regarding eligibility and authorization requirements for timely facilitation of service. Through detailed understanding of program requirements and compassionate interaction with community members and their care teams, this position will serve as a link between access to health-related social need (HRSN) services through the 1115 waiver, community members and their care teams.

Serve as the primary point of contact for our internal teams, network providers, MCOs, Medicaid Members, and other external stakeholders for all enrollment, eligibility, and authorization for HRSN and enhanced HRSN 1115 waiver services and activities.

Handle enrollment and eligibility phone calls and emails to answer questions, solve problems, and facilitate access to care for eligible Medicaid Members and their care teams.

Validate Medicaid Member enrollment and eligibility through New York State Department of Health’s Electronic Provider Assisted Claim Entry System (ePACES) to support screening, navigation, and enhanced HRSN services and assign Members to an established care team provider.

Ensure accurate enrollment and eligibility records through proactive verification and reconciliation of enrollment and eligibility file data, including identifying and resolving discrepancies.

Serve as the primary liaison between internal program leadership, and the Social Cre Network (SCN) to ensure eligibility discrepancies are updated.

Manage changes to enrollment and eligibility, documenting and communicating updates to HRSN Navigator, and Screeners. Managing communication with service providers, MCOs, and SCN to support care access and transitions of care.

Facilitate eligibility determinations for HRSN services based on established NYSDOH eligibility criteria. Manage SCN-required prior authorizations for designated enhanced HRSN services as per NYSDOH guidelines and SCN workflows.

Proactively monitor enrollment and eligibility data to assign unassigned and/or disengaged community members for screening outreach.

Maintain accurate records in accordance with New York state regulations and agency protocols.

Maintain accurate and up-to-date documentation of enrollment, eligibility, and prior authorization information needed in advance of HRSN service provision.

Support compliance tasks involving the review and management of services, and escalate any potential compliance risks to Program Leadership.

Perform other duties as assigned. This job description is not designed to cover or contain all of the required tasks, activities and/or duties that are required in this position.

Qualifications:

• Bachelor’s Degree in Human Services, Public Health or related field
• Applicable human service experience preferred.
• Experience and knowledge of the target populations and services systems preferred.
• Unrestricted driver’s license and independent, reliable means of transportation.
• Ability to work flexible hours as this position may require evening and weekend hours.

Knowledge, Skills and Abilities Required:

• Familiarity with social services or benefits administration.
• Effective questioning and active listening to gather crucial applicant information to determine program eligibility.
• Strong experience and demonstrated excellence in customer service.
• Ability to handle sensitive conversations with care, making applicants and care teams feel respected and understood.
• Knowledge of guidelines across federal, state, and local levels and ability to interpret and be trained on NYSDOH guidelines for management of HRSN services.
• Experience working with community members and care teams to determine eligibility and collaborating with care teams to obtain prior authorization for programs and services.
• Strong interpersonal and communication (oral and written) skills.
• Strong community liaison skills.
• Experience with MS Office Suite, including Word, Excel, PowerPoint, Outlook, and Zoom/Teams.
• Attention to detail; well organized; good time management skills.
• Ability to maintain professional boundaries within agency and grant guidelines, as well as with clients and external service providers.
• Ability to interact with people from diverse backgrounds within a climate of mutual respect, inclusion, enrichment, and growth.

Employment Classification: Non-exempt; Full-time 37.5 hours per week

PHYSICAL DEMANDS: The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equipment Used : Office equipment (such as computer, cellphone, fax, copy machine, shredder); motor vehicles.