Social Security Disability Specialist

Job Code: SSDS - 110

Revision Date: June 29, 2023

Starting Salary: $17.71 hourly; $36,831 annually

FLSA: Non-Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

The purpose of this job is to assist clients with chronic mental illness and/or IDD in obtaining Social Security Disability Benefits through clear, effective and efficient Medicaid Policy and Programs. This position is responsible for all aspects of complex disability claim handling, such eligibility criteria, medical and financial analysis, benefit determinations, denials and hearing representation at the Office of Disability and Adjudication Review (ODAR) as well as the Social Security Administration (SSA) claim level. This job involves fact checking, record keeping and advocacy on behalf of their clients. It follows established policies & procedures.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

• Knowledge of the principles, concepts, and methods of legal research and analysis sufficient to perform case development and documentation assignments which are typically covered by established precedents.
• Provides client services, including support for families, in a wide variety of fields, such as psychology, rehabilitation and social work.
• Ensures all state requirements are met, as well as securing all required information and submitting documentation to Social Security Administration, DDS or ODAR.
• Completes correspondence for client's medical requests (SSA correspondence, etc.).
• Processes Medicaid claims through the Community Partnership with HHSC.
• Enrolls clients requesting Affordable Healthcare Insurance.
• Reviews and analyzes cases to ensure sufficiency of evidence or documentation, and to ensure that cases are ready for hearing.
• Assists clients in completing the ADL's and Work History reports within a timely manner.
• Drafts dismissal order if case does not meet sufficient legal and regulatory requirements. Identifies other discrepancies and/or deficiencies in the file and resolves by obtaining information, documentation and other pertinent data required to process the case.
• Provides and receives information related to documentary evidence, filing and processing procedures, status of client's applications and other related areas of case processing.
• Conducts an initial interview with claimant to gather the basic facts of the case. These facts are used to help determine if the claimant meets the SSA Disability Listing of Impairments considered severe enough to prevent an individual from doing any gainful activity.
• May request the SSA to schedule a consultative examination (CE) with one of their doctors. Confirms with DDS client attended Consultative Exams.
• Manages client disputes with the Social Security Administration and provides clear and accurate information regarding client cases.
• Assist clients with Medicare in completing the application for HHSC in obtaining QMB (Qualified Medicare Beneficiary) /SLMB (Specific Low-Income Medicare Beneficiary) Medicaid assistance to assist the clients in obtaining Part D Medicare and assistance in paying for their Premiums and Co- Payments.
• Assist clients in reinstating their SSI/Medicaid benefits as well as RSDI/Medicare benefits in the event the claimant was denied after Medical review or due to clients failed attempt to go back to work and obtain substantial gainful income.
• Maintains confidentiality of all business matters.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires an Associate's Degree in Paralegal Services, Business or Public Administration or related major supplemented by two (2) years of experience in paralegal services, legal secretarial services, working with claims processing, insurance, office administration or related field; or possession of any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principles, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
• Bright/dim light; Dusts and pollen.
• Other extreme hazards not listed above.

Special Certifications and Licenses

• Texas Health and Human Service Commission (HHSC) Certification for the Community Partner Program within the time limit designated by EHN.
• Requires certification by the Texas Department of Health Services for Consumer Benefits Assistance Certification in Social Security Administration rules and regulations within the timeframe designated by EHN.
• Required to obtain HHSC Medicaid Certificate within the timeframe designated by EHN.
• Requires certification by the Texas MHIDD Consumer Benefits Organization within the timeframe designated by EHN.
• Requires certification by the Texas Department of Assistive and Rehabilitative Services for the Work Incentives Planning Supports and Service Training within the timeframe designated by EHN.
• Must possess and maintain a valid state Driver's License with an acceptable driving record.
• Must be able to pass a TB, criminal background and drug screen.

Americans with Disabilities Act Compliance (ADA)

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally-competent and recovery-oriented care.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.