Field Entitlement Enrollment Advocate Job at Healthfirst (New York)

Job Description

The Entitlement Advocate provides Healthfirst Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of financial entitlements for which they are eligible. This enables prospects and members to maintain the highest level of independence both at home and within their communities. Working under the direction of the Entitlement Manager and Team Leads, maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities. Frequently communicates moderately complex information and interacts through electronic documentation tools. This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information databases and security requirement tools such as encryption.

Job Responsibility

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
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
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

Requirements

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

Nice to have

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

What we offer

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

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