Entitlement Advocate

• Handle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals
• Screen all incoming calls and handles accordingly
• Transfer calls to appropriate staff, unit, or department
• Assist callers requesting assistance with Medicaid Renewal application, Medicare Savings Program application, and New Medicaid Applications
• Outreach Senior Health Partners, CompleteCare, and Life Improvement Plan members according to approved scripts
• Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes
• Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation
• Document all client calls /outcomes in database systems
• Schedule appointments to see members/prospects out in the field to assist with Medicaid Issue or restriction code removals or demographic information changes
• Educate potential members on Senior Health Partners, Long term care plan benefits answering questions regarding plan’s features and benefits as well as go through eligibility and requirement for enrollment
• Transfer and connect consumers seeking Long Term Care services with the state broker to complete initial evaluation (New York Independent Assessor)
• Contact prospects or primary caregiver in person (home or Community Office visit), by phone or letter to arrange an interview to assess Medicaid eligibility
• Complete Medicaid applications for New Enrollees and Renewals as needed
• Assist prospects to remove Medicaid restriction codes
• Assist prospects to Convert Market place Medicaid to Community Medicaid
• Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents
• Submit documentation to Human Resource Administration or Local Department of Social Services within specified timeframe
• Track Medicaid conversions and coverage of all submitted Applications and update status in systems
• Serve as the liaison between all parties and acts as Member advocate maximizing the participant’s support network and obtaining needed services
• Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times
• Serve as a resource for Welcome Enrollment Team, Educating new Enrollees on CDPAS information and forms
• Serves as a resource to gather missing EAA forms for Nurse Accepted Enrollments (field pick up)
• Responsible for contacting and assisting current senior Health Partners and Complete Care members who are due to recertify their healthcare coverage for Medicaid
• Contact Senior Health Partners or Complete Care members two months prior to Medicaid expiration date
• Conduct home visits and other appointments as needed to complete the application and obtain all required documentation
• Complete Monthly Medicaid renewal applications in a timely, organized fashion
• Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents
• Submit documentation to Human Resource Administration or Department of Social Services within specified timeframe to assure Medicaid coverage for participant
• Monitor Medicaid re-certification time frames for each active Medicaid member
• Ensure Human Resource Administration and/or Department of Social Services receives the renewal applications and completes re-certification of eligibility timely
• Maintain records on every member to show coverage status and timing of re-certification in TrucareHTML5 by opening assessments 2 months prior to renewal due date and closing them out when a member is fully recertified in ePACES
• Prepare/submit monthly reports
• Serve as a resource to Care Management Teams, Sales Teams and Nurses for Medicaid and Medicare savings Programs eligibility
• Keep up to date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and shares information with other Social Work and Care Team members as appropriate
• Participate in relevant entitlement training/meetings
• Maintain contact between participant/primary support, business office, social worker, marketing specialists and enrollment specialists to keep parties updated regarding progress of MA and other entitlement applications
• Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed
• Engage in mastering the Divisions impact on Healthfirst and its Members
• Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects
• Maintain the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contacts
• Assists with orientation of new Hires so they understand the model, support enrollment growth and can answer routine questions about the program
• Successfully meet pre and post training and regulatory exams and audit requirements
• Arrive at scheduled work site, team meetings, training sessions and events in accordance to departmental policy
• Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient
• Handle other duties as assigned with the occasional need to work weekends, additional hours before or after shift schedule and/or from other HF site locations

• High school diploma or GED from an accredited institution
• Member facing or customer service experience
• Be able to work 9am-5:30pm schedule
• Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
• Capability to work in a Hybrid Schedule (remote/office/field)
• Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint
• Bilingual
• Be able to communicate and engage with the leadership team on virtual platforms such as Zoom or Microsoft Teams chat as well as in person

• Associate degree from an accredited institution plus 1 year of related work experience including inbound and outbound call center within a healthcare environment
• Telephonic experience with frail adult or elderly population
• A solid understanding of the value of integrated care
• Experience in health insurance, home care environment, acute, sub-acute, long-term care setting, or managed-long term care
• Have access to a vehicle with valid proof of insurance and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
• Experience managing member information or appointments in a shared network environment using paperless database modules
• Adept at operating within a multi-cultural work environment
• Bilingual
• Prior experience with Medicaid /Medicare Savings Program

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions