Healthfirst

The Bilingual (Spanish and/or Man/Can) Sr Retention Advocate (SRA) is responsible for educating and providing Healthfirst members support to obtain financial entitlements for which they are eligible that enable members to maintain the highest level of independence both at home and within their communities. The SRA provides members education about cost-saving programs, assists our members in applying for programs for which they are eligible, and provides follow-up support. They will be responsible for a cycle of work that requires managing a case from start to finish. This role manages multiple tasks independently, utilizing a fast-paced proactive vs. reactive approach to changing priorities. The SRA frequently communicates with members to provide moderately complex information in person and by interacting through electronic documentation tools. The SRA works in a paperless work environment that requires daily hands-on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools, including encryption. These systems include, but are not limited to, TrucareHTML5, RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office 360 software (such as Word, Excel and Outlook), Interaction Client, Jabber, and related systems.

• Contacts members and/or primary caregivers by phone or letter to arrange a telephonic or in-person interview to assess Medicaid/Medicare/Medicare Savings Program eligibility. Ensures all calls and conversations are conducted in accordance with approved Healthfirst expectations. 

• Educates and provides Healthfirst members support to obtain financial entitlements for which they are eligible

• Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, requiring utmost integrity and discretion

• Serves as an advocate between all parties maximizing the participant’s support network and assists members in obtaining needed services

• Researches designated tools and platforms concerning eligibility, exclusion, and exemption codes

• Consults with Human Resource Administration (HRA)/Local Department of Social Services (LDSS) Medicaid staff as needed and reports to supervisor about any need for HRA/LDSS consultation

• Tracks the Medicaid/Medicare/MSP status for all members on an ongoing basis until all member entitlements are resolved

• Assists members with completing designated application in a timely, organized fashion and assists participant or primary caregiver in the completion of the application

• Assists in collecting all required documents for applications

• Submits documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage for the member

• Monitors all applications according to HRA/LDSS/Social Security office/Medicare time frames

• Documents all client calls /outcomes in database system and spreadsheets

• Responsible for tracking work, maintaining accurate data, presenting it, and following up promptly

• Prepares/submits monthly reports to Management

• Additional duties as appropriate or as directed

 

Ongoing Knowledge & Support

• Monitors and maintains awareness and understanding of changes in Medicaid/Medicare/HMO laws; collaborates and shares information with other Team members as appropriate

• Participates in entitlement training/meetings, as directed

• Understands and develops how the department impacts and works with Healthfirst’s operations overall to benefit its members

• Contributes creative solutions and takes ownership of daily assignments to ensure effective communication and systematic completion of routine and special projects

• Maintains the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contacts

• Assists with the orientation of new hires to educate them on the model, support enrollment growth and can answer routine questions about the program.

• Handles 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

• Experiences managing member information or appointments in a shared network environment using paperless database modules  

 

Minimum Qualifications:

• High School diploma or GED from an accredited institution

• Has the ability to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County

• Well organized, detail oriented, and adaptable to procedural and other changes

• Strong data entry skills and a demonstrated ability to maintain monthly spreadsheets for tracking and statistical purposes

 

Preferred Qualifications

• Associate degree from an accredited institution

• Prior experience with Medicaid /Medicare/Medicare Savings Program

• Prior experience working with an adult or elderly population

• Customer service experience, preferably in an inbound and outbound call center within a healthcare environment

• A competent understanding of integrated care

• Experience in health insurance, a home care environment, acute, sub-acute, long-term care (LTC) setting, or managed-long term care (MLTC)

• At least five years in a health plan sales role with a proven record of consistently producing maximum results in a compliant manner.

 

Compliance & Regulatory Responsibilities: Noted above

 

License/Certification: N/A

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070

• All Other Locations (within approved locations): $51,000 - $74,880

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. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.