Field Entitlement Enrollment Specialist

Description and Requirements

The Sr Retention Advocate (SRA) is responsible for educating and providing Healthfirst members support to obtain financial entitlements for which they are eligible, to enable members to maintain the highest level of independence both at home and within their communities. The SRA provides education about cost-saving programs, assists Healthfirst members in applying for programs for which they are eligible, and provides follow up support. They are responsible for a cycle of work that requires managing a case from start to finish. This role manages multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities. The SRA frequently communicates with members to provide moderately complex information in person and/or by interacting through electronic documentation tools. The SRA works in 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, and related systems.

Duties & Responsibilities:

• Contacts 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 and conversations are conducted in accordance with approved Healthfirst expectations
• 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 and liaison to maximize the member's support network and to obtain 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 report to supervisor any need for HRA/LDSS consultation
• Tracks the Medicaid/Medicare/MSP status for all members on an ongoing basis to assist that all member entitlements are gained
• Completes designated application(s) in a timely, organized fashion and assists member 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 regarding 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, and presenting it, and following up promptly as warranted
• Prepares/submits monthly reports to Management
• Additional duties as appropriate or as directed

• Monitors and maintains awareness and understanding of changes in Medicaid/Medicare/HMO laws, and collaborates and shares information with other team members as appropriate
• Participates in entitlement training/meetings, as directed
• Engages in mastering and understanding how the work of the department impacts Healthfirst's overall operations and 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, other team members, 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 and/or 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

• High School diploma or GED from an accredited institution
• Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
• Well organized, detail oriented, and able to adapt to procedural and other changes
• Strong data entry skills and a demonstrated ability to maintain monthly spreadsheets for tracking and statistical purposes

• Associate degree from an accredited institution
• Prior experience with Medicaid /Medicare/Medicare Savings Program
• Experience in an inbound and outbound call center within a healthcare environment
• Prior experience working with an adult or elderly population
• 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.