Description and Requirements
The Sr Retention Advocate is responsible to educate and provide Healthfirst members support in obtaining financial entitlements for which they are eligible. This enables members to maintain the highest level of independence both at home and within their communities. Education within Medicare, the Medicare Savings Program (MSP), assist our members in applying and continuous follow up to eligibility. S/he will be responsible for a longer cycle of work. Working under the direction of the Entitlement Manager and Team Lead, 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 (PHI) databases and security requirement tools such as 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, etc.
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Duties & Responsibilities:
- Contact member or primary caregiver by phone or letter to arrange a telephonic or in person interview to assess Medicaid/Medicare/Medicare Savings Program eligibility. Ensures all calls are in accordance to approved Healthfirst scripts
- Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, always calling for the utmost integrity
- Serves as an advocate between all parties maximizing the participant's support network and obtaining needed services
- Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes
- Consult with Human Resource Administration (HRA)/Local Department of Social Services (LDSS) Medicaid staff as needed and report to supervisor any need for HRA/LDSS consultation
- Track the Medicaid/Medicare/MSP status for all members on an ongoing basis until all member entitlements are gained
- Completes Medicaid/MSP 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
- Submit documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage for participant
- Monitor all applications according to HRA/LDSS/Social Security office/Medicare time frames
- Documents all client calls /outcomes in database system and spreadsheets
- Responsible for prolonged cycles of work, must maintain accurate data and be able to present it and follow up promptly
- Prepare/submit monthly reports to Management
Ongoing Knowledge & Support:
• Keep up to date on changes in Medicaid/Medicare/HMO laws and shares information with other Team members as appropriate
• Participate in relevant entitlement training/meetings
• 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.
• 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
• Experience managing member information or appointments in a shared network environment using paperless database modules
Required
• Minimum Education: High School diploma or GED
• Prior experience with Medicaid /Medicare/Medicare Savings Program
• Experience in inbound and outbound call center within a healthcare environment
• Have access to a vehicle and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
• Well organized, detail oriented, and bale to adapt to procedural and other business information changes
• Strong data entry skills, must be able to maintain monthly spreadsheets for tracking and statistical purposes
Preferred
• Associate degree from an accredited institution
• Prior experience working with the 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 (LTC) setting or managed-long term care (MLTC)
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960
- All Other Locations (within approved locations): $49,795 - $72,800
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.