Job Details

Purpose:  The Michigan Drug Assistance Program (MIDAP) is responsible ensuring that HIV/AIDS patients who qualify have access to prescription medications and are retained in care. This position will be responsible for working with a team of dedicated staff to assist clients with benefit claims through a Pharmacy Benefit Manager (PBM) and to access care through insurance premium assistance. MIDAP plays a key role in balancing the federal requirements of cost containment and cost avoidance while ensuring that Michigan’s clients receive quality services.

Duties and Responsibilities:

• Verify eligibility and direct members to client groups in the PBM system.
• Determine eligibility for premium assistance for Medicare Part D, Pre-existing Conditions Insurance, COBRA and private policies.
• Direct non-eligible clients to other systems of care.
• Process payments made by MDCH for the purpose of insurance premiums and all others required by MIDAP including vaccines, refunds etc... And maintain a system for tracking payments.  
• Process pharmacy claims and premium assistance payments and maintain a tracking and reporting system.
• Coordinate with MDCH accounting to make claim or payment adjustments and ensure accuracy and timeliness of payments.
• Code and input data into the PBM system to pay claims.
• Assist the MIDAP Coordinator, working with the PBM on direct member reimbursements, claims, recovery and fiscal oversight.
• Review eligibility data at least twice monthly and submit data and/or redirect costs to Medicaid.
• Serve as staff liaison to the MDCH Bureau of Laboratories to monitor costs charged to MIDAP for services provided; attend periodic meetings and prepare reports for management.
• Contact health services providers and others to locate medical information and documentation; assemble documentation for program and audit purposes.  
• Utilize on-line systems to verify, update and process information.
• Compile reviews, and monitor financial, statistical and programmatic data for state or federal reporting.
• Provide program support when necessary to provide back up support to other positions in MIDAP.
• Assist in development of quality assurance activities to develop oversight to reduce fraud and ensure accountability and transparency of state and federal funds.
• Contribute to Division activities including development of strategic plans, transition to the Affordable Health Care and Medicaid Expansion environments and participate on MDCH teams.
• Participate in all required trainings, including confidentiality and security trainings and sign oath of confidentiality.
• Other duties are assigned by the MIDAP/MDP Coordinator, Continuum of Care Unit Manager or Section Manager.