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General Information

Req ID
New York
Work Type

Description and Requirements

The Entitlement Advocate provides Healthfirst’s 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. These systems include but are not limited to TrucareHTML5 , Sunguard MACESS Service Module (electronic archiving), Salesforce, ePACES, RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office Suite (such as Word, Excel and Outlook), Interaction Client, Jabber, etc.

SHP Renewal Line: (Inbound/Outbound):

  • 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

Growth (Educate and Assess for Medicaid Eligibility):

  • 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).

Retention (Assist with Renewal of Members Medicaid eligibility):

  • 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.

Other duties:

  • 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.

Minimum Qualifications:

  • High school diploma or GED from an accredited institution 
  • Bilingual
  • 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.
  • 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

Preferred Qualifications:

  • Associates degree from an accredited institution plus 1 year of related work experience including inbound and outbound call center within a healthcare environment.
  • Work experience within the healthcare industry:
  • Prior experience with Medicaid /Medicare Savings Program
  • 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 diverse and multi-cultural work environment

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400

  • All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.