Sr. Retention Advocate

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 Trucare

HTML5, Right Fax, 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.

• 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

• 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

• 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…