Healthfirst

The Entitlement Advocate provides members and prospects with obtaining and retaining 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 Integrated Products management maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities. Frequently communicates 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, 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.

Job Description

Duties and Responsibilities

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.

· Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes.

· Consult with HRA Medicaid staff as needed and report to the 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):

· Contact prospects or primary caregivers 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 a specified timeframe.

· Track Medicaid conversions and coverage of all submitted Applications and update status in systems.

· Serve as the liaison between all parties and act as Member advocate maximizing the participant’s support network and obtaining needed services.

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.

· Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.

· 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.

· Maintain records on every member to show coverage status and timing of re-certification in Salesforce.

Other duties:

· Serve as a resource 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 share information with other staff members as appropriate.

· Participate in relevant entitlement training/meetings.

· Maintain contact between participant/primary support, business office, regarding progress of MA and other entitlement applications.

· Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed.

· 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 sites, team meetings, training sessions and events in accordance with 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.

Job Qualifications:

Minimum Qualifications:

· High school diploma or GED from an accredited institution

· Member facing or customer service experience

· Be able to work 9am-5:30pm schedule Monday-Friday

· 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

Preferred Qualifications:

Associate 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

· Bilingual

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. 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.