Experience Inc. Jobs

Duties and Responsibilities

• Conducts daily screening of applications. This includes monitoring applications submitted for deadlines, monitoring applications due to the Local Department of Social Services for faster and more accurate enrollment and conducting pre-screenings for financial eligibility.

• Identifies obstacles and opportunities for enrollment through verification of submitted application by the Senior Retention AdvocateTeam.

• Assists with orientation of new Senior Retention Advocate and Senior Retention Advocate Liaisons so they understand the model, support enrollment growth and can answer routine questions about the program.

• Facilitates problem-solving for performance improvement.

• Contributes to the teams efforts to treat and support every enrollee with respect, courtesy and fairness in a way that provides superior customer service.

• 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.

• Assist the Senior Retention Advocate Advocate team on a monthly basis to review ePACES for the Complete Care and Senior Health Partners recertification population.

• Monitor and Control of the Withdrawal, Mailroom Submissions and MCS mailboxes on a daily basis to ensure all inquiries are processed timely.

• Assists Marketing Specialists, Medicare representative, Care Teams and Retention department in gaining and regaining member eligibility by communicating with Local Department Of Services offices on all escalated cases.

• Outreaches Human Resources Administration to review and assist with escalated cases by working in conjunction with the dedicated liaison through email and phone.

• Assist the Pooled Trust team to submit new Trust documents for our members to the Human Resource Administration for the removal of spenddown amounts.

• Assist the Care Teams and Enrollment and Billing teams to relink cases that have active coverage but are not linked to Healthfirst plans in the system by providing proof of services.

• Assist the Disenrollment team in reviewing all membership that has inactive Medicaid coverage by assigning case to be worked on by the Entitlement Advocate team and following up on them weekly until they are Eligible/active.

• Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity and adherence to Protected Health Information (PHI) at all times.

• Assist Intake and Care Teams in confirming Medicaid eligibility upon referral by Enrollment or Care Teams.

• Document status of Medicaid and entitlement coverage in designated systems.

• Prepare/submit monthly reports.

• Serve as a resource to the Sales Teams for Medicaid Eligibility and other Medicare Savings Program.

• Keep up-to-date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and shares information with other Social Work and Care Team members as appropriate.

• Participate in relevant entitlement training/meetings internally and externally.

• Maintain contact between participant/primary support, business office, social worker and enrollment specialist to keep parties updated regarding progress of MA and other entitlement applications.

Minimum Qualifications:

• High School diploma or GED from an accredited institutionplus 1 year of related work experience

• Capability to work in a Hybrid Schedule (remote/office/field)

• Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint.

• Be able to communicate and engage with the leadership team on virtual platforms such as Zoom or Microsoft Teams chat as well as in person

Preferred:

• Associate degree from an accredited institutionplus 3 year of related work experience including inbound and outbound call center within a healthcare environment.

• Work experience within the healthcare industry

• Prior experience with Medicaid /Medicare Savings Program

• Experience in health insurance, home care environment, acute, sub-acute, long-term care setting, or managed-long term care

• Experience managing member information or appointments in a shared network environment using paperless database modules

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.