Coordinator, Disability Advocacy Program (CSHCS)

Position Summary:

The Coordinator, Disability Advocacy Program is responsible for the preparation of case management files for assigned Plan members who are eligible to receive Children Special Healthcare Services (CSHCS) benefits and the documentation of progress toward achieving additional benefits in the CSHCS database.

Key Responsibilities:

• Prepare case management files for assigned Plan members who are eligible to receive Children Special Healthcare Services (CSHCS) benefits.
• Document progress toward achieving additional benefits in the CSHCS database.
• Coordinate with the Supervisor/Manager of the Disability Advocacy Program, CM/UM associates, and Enterprise Analytics to receive monthly data loads.
• Distribute member data to other departments, as needed, to improve member engagement and coordination for a single-member experience.
• Coordinate and facilitate the CSHCS conversion application process by working closely with members, providers, Population Health associates, and local and federal agencies, as needed, including Medicaid agencies.
• Coordinate with providers to facilitate the exchange of medical documentation regarding specialty treatment received for designated chronic medical conditions.
• Review claims as part of the CSHCS eligibility and coordination process.
• Maintain frequent contact with members, medical services, government services, providers, and others to provide updates throughout the ongoing process.
• Obtain and verify medical information needed to determine CSHCS eligibility.

Education and Experience:

• Associate’s degree required.
• 3 to 5 years of managed care experience required.

Preferred Skills:

• Experience working with individuals with disabilities and diverse member populations in a case management, social services, or healthcare setting.
• Knowledge of medical terminology, medical record documentation, and healthcare information management practices.
• Knowledge of and experience in Children’s Special Health Care Services program and medical claims processing.
• Proficiency with healthcare systems and applications, including EXP, RightFax, and Microsoft Office Suite.
• Understanding of case management referral processes and applicable state regulations and requirements.
• Ability to identify, engage, and leverage cultural, social, and community-based resources to support member needs and promote positive outcomes.
• Strong communication, organization, and relationship-building skills, with the ability to collaborate effectively with members, providers, community partners, and internal teams

Our Comprehensive Benefits Package Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more. Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you. About AmeriHealth Caritas Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com