Intake Navigator

JOB PURPOSE:

The Intake Navigator will directly educate a prospective participant through the onboarding process leading to enrollment in Center Light’s Program of All-inclusive Care for the Elderly (PACE). This person will work closely with referral sources, account managers, clinical intake and provider relations to ensure all and tasks are efficiently completed associated with the enrollment process. The Intake Navigator is expected to maintain ethical conduct, compliance with state, federal and PACE regulatory requirements, and will be responsible for quality and satisfaction of prospective participants, caregivers and referral sources.

JOB RESPONSIBILITIES:

Correspond directly with the prospective participants to provide plan education and qualification screening. Respond to all incoming/outgoing calls, data entry, emails. schedule assessments and mail information to prospective participant. Meet the departmental productivity goals as specified by management for the growth of the company. Become an expert about Center Light PACE program eligibility requirements, services and benefits. Address eligibility issues, application processing and referrals to Maximus to resolve potential participant issues.

Work closely with all departments to onboard and retain participants. Obtain referral details to assess and determine appropriate next steps for expeditious enrollment processing. Evaluate factors unique to each referral including, but not limited to their clinical condition, financial situation, their entitlements status and home support systems. Use knowledge obtained through the qualification screening to determine which government agencies and team members (entitlements specialists, assessment nurses, etc.)

should be assigned to the prospect or caregiver in the next step of enrollment. Verify plan and entitlement status utilizing LDSS/HRA/CMS resources and functions. Perform provider network verification and other validation of provider participation. Enter calls/inquiries into central database for tracking and follow-up and schedule appointments with the prospect/caregiver. Monitor and report Intake team performance measures to improve delivery and execution of onboarding procedures (CDPAS enrollment, acquisition of entitlements, logistical delivery of service plans, request for provider network recruitment, etc.).

Maintain and generate reports to measure performance and quality of work as set forth by Center Light. Participate in implementing workflows and Standard Operating Procedures. Advise on the development of tools and process improvements to increase quality and departmental operational efficiencies. Collect and review completeness of all required documents for processing enrollment transactions and reconciliation of enrollment files. Provide training and process orientations to Business Development team members and other business functions as needed Maintain knowledge of all applicable CMS, DOH, and PACE-specific guidelines, including organizational and departmental policies and procedures.

Maintain compliance with Medicaid, Medicare, and PACE regulations. All other duties as assigned or requested.

Weekly

Hours:

40

Schedule:

8:30AM – 5:30 PM

• Education:
  
  High School Diploma required, Associate Degree preferred.
• Experience:
  
  Minimum 2 years work experience in healthcare; preferably with MLTC, MAP, or PACE programs and/or homecare; primarily in intake/enrollment functions.
• Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment.
• Proficiency with CRM platforms; knowledge of Care Compass strongly preferred.
• Knowledge of Maximus, eMedNY, ePACES, CMS MARx and other related HRA/CMS resources and functions, preferred.
• Proficiency in Microsoft Excel, Word. Outlook and Teams.
• Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while meeting targets and projections and performing daily tasks.
• Highly organized and flexible to meet submission deadlines.
• Experience in working independently without significant oversight and or direction from a supervisor.
• Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage and services of various public programs a plus.
• Familiarity with healthcare organizations and general population dynamics within the greater New York Metropolitan region a plus.
• Other:
  Excellent written and oral…