Field Entitlement Advocate

The Entitlement Advocate provides Healthfirst’s Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of 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, 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 databases and security requirement tools such as encryption. These systems include but are not limited to TrucareHTML5 , Sunguard MACESS Service Module (electronic archiving), Salesforce, ePACES, Right Fax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office Suite (such as Word, Excel and Outlook), Interaction Client, Jabber, etc.

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.
• 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 /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 Asess for Medicaid Eligibility):

• Educate potential members on Senior Health Partners, Long term care plan benefits answering questions regarding plan’s features and benefits as well as go through eligibility and requirement for enrollment.
• 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 caregiver in person (home or Community Office visit), by phone or letter 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 specified timeframe.
• Track Medicaid conversions and coverage of all submitted Applications and update status in systems.
• Serve as the liaison between all parties and acts as Member advocate maximizing the participant’s support network and obtaining needed services.
• Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times.
• Serve as a resource for Welcome Enrollment Team, Educating new Enrollees on CDPAS information and forms.
• Serves as a resource to gather missing EAA forms for Nurse…