Bilingual Senior Retention Advocate

• Contacts members and/or primary caregivers by phone or letter to arrange a telephonic or in-person interview to assess Medicaid/Medicare/Medicare Savings Program eligibility. Ensures all calls and conversations are conducted in accordance with approved Healthfirst expectations.

• Educates and provides Healthfirst members support to obtain financial entitlements for which they are eligible

• Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, requiring utmost integrity and discretion

• Serves as an advocate between all parties maximizing the participants support network and assists members in obtaining needed services

• Researches designated tools and platforms concerning eligibility, exclusion, and exemption codes

• Consults with Human Resource Administration (HRA)/Local Department of Social Services (LDSS) Medicaid staff as needed and reports to supervisor about any need for HRA/LDSS consultation

• Tracks the Medicaid/Medicare/MSP status for all members on an ongoing basis until all member entitlements are resolved

• Assists members with completing designated 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

• Submits documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage for the member

• Monitors all applications according to HRA/LDSS/Social Security office/Medicare time frames

• Documents all client calls /outcomes in database system and spreadsheets

• Responsible for tracking work, maintaining accurate data, presenting it, and following up promptly

• Prepares/submits monthly reports to Management

• Additional duties as appropriate or as directed

Ongoing Knowledge & Support

• Monitors and maintains awareness and understanding of changes in Medicaid/Medicare/HMO laws; collaborates and shares information with other Team members as appropriate

• Participates in entitlement training/meetings, as directed

• Understands and develops how the department impacts and works with Healthfirsts operations overall to benefit its members

• Contributes creative solutions and takes ownership of daily assignments to ensure effective communication and systematic completion of routine and special projects

• Maintains the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contacts

• Assists with the orientation of new hires to educate them on the model, support enrollment growth and can answer routine questions about the program.

• Handles 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

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

Minimum Qualifications:

• High School diploma or GED from an accredited institution

• Has the ability to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County

• Well organized, detail oriented, and adaptable to procedural and other changes

• Strong data entry skills and a demonstrated ability to maintain monthly spreadsheets for tracking and statistical purposes

Preferred Qualifications

• Associate degree from an accredited institution

• Prior experience with Medicaid /Medicare/Medicare Savings Program

• Prior experience working with an adult or elderly population

• Customer service experience, preferably in an inbound and outbound call center within a healthcare environment

• A competent understanding of integrated care

• Experience in health insurance, a home care environment, acute, sub-acute, long-term care (LTC) setting, or managed-long term care (MLTC)

• At least five years in a health plan sales role with a proven record of consistently producing maximum results in a compliant manner.

Compliance & Regulatory Responsibilities : Noted above

License/Certification : N/A

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $58,900 - $79,040

All Other Locations (within approved locations): $51,000 - $74,880

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

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.