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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 participants 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)

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.