MAP Sales Representative II - NYS , Accident and Health NY

Position Overview

Metro Plus
Health
is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Medicaid Advantage Plus (MAP) Sales Representative II provides access to MAP insurance, by providing education and assistance to dual-eligible Medicaid and Medicare long-term care recipients. The MAP Sales Representative III provides education on Medicaid Advantage Plus features and benefits to consumers, providers, and business partners.

Scope of Role & Responsibilities

• Educate and enroll dual-eligible Medicaid and Medicare consumers for the Metro Plus Health  Medicaid Advantage Plus (MAP) product.
• Identify dual-eligible Medicaid and Medicare consumers via Home Care Agencies, Adult Day Care Centers, DME Provider offices, Caregiver Resources Centers, specialty provider offices, HHC Long-Term Care Facilities, etc.
• Understand and apply all policies and procedures pertaining to:
  • Disclosures and provisions of the various Metro Plus Health  Plan products.
  • Enrollment and disenrollment for the MAP line of business.
  • Complete enrollment calls and workflows resulting in smooth initial and plan-to-plan transfers
• Remain knowledgeable of services available and utilized by dual-eligible Medicaid and Medicare consumers eligible for MAP, i.e., State benefits, rehabilitation therapies, personal care, chore services and housekeeping, social adult day care, dental care, etc.
• Responsible for understanding the basic concepts, features, benefits of Metro Plus Health  MAP products.
• Responsible for selling the services provided by the Plan, such as covered benefits, non-covered benefits, exclusions and exemptions.
• Provide education on Medicaid Advantage Plus Plan features and benefits to consumers, providers, and business partners.
• Responsible for remaining informed of, and adhering to, marketing activity guidelines as set forth by various agencies such as HRA, DSS, SDOH.
• Responsible for assisting the consumer with the following:
  • Selecting a PCP
  • Completing required marketing materials and documentation as determined by Metro Plus Health  and various regulatory agencies such as HRA, DSS, SDOH.
  • Completion of enrollment form, required documents and reports i.e. transmittal reports, batch sheets top process an application for dual-eligible Medicare and Medicaid consumer eligible for MAP.
• Follow up on “Leads” and “Referrals” from family members, and caregivers of consumers eligible for enrollment in the Metro Plus Health  MAP product.
• Responsible for always maintaining an adequate supply of marketing materials.
• Conduct presentations to Home Care Agencies, support groups, caregiver trainings, etc. as well as conduct home visits, and personalized appointments as needed to complete the enrollment process.
• Routinely travel within Plan’s service area to conduct presentations to Home Care Agencies, support groups, caregiver trainings, etc. as well as conduct home visits, and personalized appointments as needed to complete the enrollment process.
• Routinely travel within Plan’s service are to ensure that promotional activities are conducted to promote the Metro Plus Health  MAP (i.e., placement of signage and brochures in patient waiting areas, conduct outreach calls, participate in events/health fairs and workshops attended by consumers, caregivers, and providers) including evening and weekend hours.
• Work closely with Outreach Representatives, Member Service Representatives, Eligibility Representatives, Utilization Management, and other Metro Plus Health  personnel to resolve member concerns regarding complaints and potential…