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Job Type
Full Time
Job Details
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 TrucareHTML5, RightFax, 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. Duties & Responsibilities:
- 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
- Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
- All Other Locations (within approved locations): $41,101 - $60,320
About the Company
Healthfirst, Inc.
New York City, NY, United States
Healthfirst is one of the nation’s largest not-for-profit health insurers, offering members access to high-quality, affordable healthcare. The... Read more