Entitlement Advocate- Bilingual Spanish or Cantonese​/Mandarin

The Entitlement Advocate provides Healthfirst Medicare Advantage Plan (MAP), Managed Long‑Term Care Plan (LTC), Dual‑eligible Medicare Plan and Nursing Home 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 the Entitlement Manager and Team Leads, the Advocate maneuvers multiple tasks independently with a fast‑paced proactive 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 databases and security requirement tools such as encryption.

• Handle inbound and outbound calls to and from customers, addressing their needs while adhering to service level goals.
• Screen all incoming calls and handle them accordingly.
• Transfer calls to appropriate staff, unit, or department.
• Assist callers requesting assistance with Medicaid Renewal, Medicare Savings Program, and new Medicaid applications.
• Outreach Senior Health Partners, Complete Care, and Life Improvement Plan members according to approved scripts.
• Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes.
• Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation.
• Document all client calls and outcomes in database systems.
• Schedule appointments for field assistance with Medicaid issues, restriction code removals, or demographic changes.

• Educate potential members on Senior Health Partners and Long‑Term Care plan benefits, answering questions regarding plan features and enrollment requirements.
• Transfer and connect consumers seeking Long Term Care services with the state broker to complete initial evaluation (New York Independent Assessor).
• Contact prospects or primary caregivers in person, by phone, or letter to arrange an interview for Medicaid eligibility assessment.
• Complete Medicaid applications for new enrollees and renewals as needed.
• Assist prospects in removing Medicaid restriction codes.
• Assist prospects in converting Marketplace Medicaid to Community Medicaid.
• Facilitate compilation of all required documents, contacting landlords, employers, bankers, and insurance companies as necessary.
• Submit documentation to Human Resource Administration or Local Department of Social Services within specified time frames.
• Track Medicaid conversions and coverage of all submitted applications, updating status in systems.
• Serve as liaison between all parties, acting as member advocate, maximizing support networks, and obtaining needed services.
• Maintain full access to patient records and reports, ensuring integrity at all times.
• Serve as a resource for the Welcome Enrollment Team, educating new enrollees on CDPAS information and forms.
• Gather missing EAA forms for Nurse Accepted Enrollments (field pickup).

• Contact and assist current Senior Health Partners and Complete Care members due for Medicaid recertification.
• Contact members two months prior to Medicaid expiration.
• Conduct home visits and appointments as needed to complete applications and gather documentation.
• Complete monthly Medicaid renewal applications promptly and organized.
• Facilitate document compilation, contacting landlords, employers, bankers, and insurance companies as required.
• Submit documentation to Human Resource Administration or Department of Social Services within specified time frames.
• Monitor Medicaid re‑certification time frames for each active member.
• Ensure Human Resource Administration and/or Department of Social Services receives renewal applications and completes re‑certification timely.
• Maintain member records showing coverage status and recertification timing in TrucareHTML5, opening assessments two months prior to renewal and closing them when fully recertified.
• Prepare and…