Benefits Case Manager

Overview

Join a Team That Changes Lives

For more than 170 years, Elwyn has been leading the way in supporting children, teens, and adults with autism, intellectual and developmental disabilities, and behavioral health challenges. As a mission-driven nonprofit, we’re here to create real change – helping people lead meaningful, fulfilling lives.

Now, we’re looking for passionate team members to join us. Here, your work will change lives – including your own. You’ll make an impact every day, find purpose in what you do, and grow in a career that truly matters.

At Elwyn, we take care of you while you care for others. We offer:

• Generous Paid Time Off
• Comprehensive Medical/Dental/Vision Benefit Packages
• Earned Wage Access/On-Demand Pay
• Paid On-the-Job Training
• Tuition Reimbursement
• Career Advancement Opportunities and Growth
• Flexible Schedules
• Retirement Savings Plan

Join us and be a part of something bigger. Apply today.

Job Description

The Benefits Case Manager is responsible for assisting individuals served by Adult Behavioral Health programs with applying for and maintaining active health insurance and public benefits. This position supports insurance eligibility verification, enrollment and renewal processes, and resolution of coverage issues to promote continuity of care and minimize interruptions in services and reimbursement.

The Benefits Case Manager works collaboratively with program leadership, clinical teams, billing, and external agencies to identify and resolve benefits-related issues in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Verify health insurance eligibility and active coverage for individuals served by Adult Behavioral Health programs
• For Rhode Island programs, routinely verify that each individuals health insurance remains active, including applicable Medicaid and managed care coverage
• Complete insurance eligibility checks at intake, admission, periodically thereafter, and whenever a change in coverage is reported or suspected
• Identify inactive, terminated, suspended, or otherwise problematic coverage and promptly notify the Regional Director
• Maintain an accurate tracking system documenting insurance status, verification dates, identified issues, and resolution efforts
• Coordinate with insurance carriers and state agencies, as appropriate, to resolve eligibility and enrollment discrepancies
• Inactive coverage is followed through to resolution, with documented follow-up and escalation when necessary
• Leadership receives accurate and timely reporting on insurance status and unresolved barriers
• Records are maintained accurately and in accordance with Elwyn's requirements
• Benefits Enrollment and Maintenance
• Assist individuals with applications, renewals, recertifications, and other documentation needed to maintain health insurance and eligible public benefits
• Help individuals understand notices regarding insurance eligibility, renewals, denials, and termination of benefits
• Coordinate with the appropriate state agencies, including Medicaid and other public benefits offices, to address outstanding applications and coverage issues
• Track renewal deadlines and follow up to reduce the risk of lapses in coverage
• Assist individuals in obtaining and submitting required documentation and identifying available resources when eligibility issues arise
• Coordination with Programs and Billing
• Collaborate with program directors, clinical staff, and billing to identify individuals with inactive or unresolved insurance coverage
• Notify appropriate leadership staff promptly when coverage is inactive or a lapse may affect service access or reimbursement
• Support admissions and transitions between programs by confirming insurance information and identifying benefits-related barriers
• Participate in revenue cycle meetings and operational meetings as needed to address benefits issues
• Documentation and Reporting
• Maintain accurate, timely, and confidential records of insurance verification, benefits of applications, renewal activity, and follow-up
• Develop and maintain an insurance eligibility tracker for designated programs, including status, date verified, and outstanding action items
• Provide routine reports to leadership regarding active coverage rates, pending renewals, inactive coverage, unresolved eligibility issues, and corrective actions
• Identify any recurring barriers to maintaining coverage and recommend improvements to internal processes
• Ensure documentation and handling of personal information comply with applicable privacy requirements and organizational policies
• Individual Support and Advocacy
• Educate individuals about their insurance coverage, benefits, and responsibilities for maintaining eligibility
• Assist individuals in navigating insurance and public benefits systems, scheduling appointments with benefit resources, transporting, participate in meetings with individuals and benefit resource personnel
• Advocate with appropriate agencies and insurers to resolve barriers to coverage
• Refer individuals to additional resources when needs fall outside the scope of the position

QUALIFICATIONS

• Associate's or bachelor's degree in human services, social services, healthcare administration, or a related field preferred; equivalent relevant experience may be considered
• Experience with health insurance eligibility, Medicaid, managed care, or public benefits programs preferred
• Knowledge of insurance enrollment, renewal, and eligibility processes in Rhode Island
• Strong organizational, follow-up, documentation, and communication skills
• Ability to manage multiple cases, track deadlines, and resolve outstanding issues
• Proficiency with electronic health records, eligibility verification systems, spreadsheets
• Ability to maintain confidentiality and work effectively with individuals served, program staff, leadership, and state agencies

Equal Opportunity Employer

Elwyn is an Equal Opportunity Employer. Elwyn does not discriminate on the basis of race, color, religion, creed, ancestry, pregnancy status, medical condition, gender, gender identity or expression, genetic information, sexual orientation or identity, age, national origin, citizenship, handicap status, marital or family status, mental or physical disability, perceived disability, military or veteran status, political activities or affiliations, or any other characteristic protected under applicable federal, state or local law, ordinance, or regulation.

If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information.

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