Field Entitlement Enrollment Specialist

The Sr Retention Advocate (SRA) is responsible for educating and providing Healthfirst members support to obtain financial entitlements for which they are eligible, to enable members to maintain the highest level of independence both at home and within their communities. The SRA provides education about cost-saving programs, assists Healthfirst members in applying for programs for which they are eligible, and provides follow up support. They are responsible for a cycle of work that requires managing a case from start to finish.

This role manages multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities. The SRA frequently communicates with members to provide moderately complex information in person and/or by interacting through electronic documentation tools. The SRA works in 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, and related systems.

Duties & Responsibilities:

• Contacts 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 and conversations are conducted in accordance with approved Healthfirst expectations 
• 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 and liaison to maximize the member’s support network and to obtain 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 report to supervisor any need for HRA/LDSS consultation
• Tracks the Medicaid/Medicare/MSP status for all members on an ongoing basis to assist that all member entitlements are gained
• Completes designated application(s) in a timely, organized fashion and assists member 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 regarding 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, and presenting it, and following up promptly as warranted
• 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, and collaborates and shares information with other team members as appropriate
• Participates in entitlement training/meetings, as directed
• Engages in mastering and understanding how the work of the department impacts Healthfirst’s overall operations and 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, other team members, 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 and/or 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
• Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
• Well organized, detail oriented, and able to adapt 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
• Experience in an inbound and outbound call center within a healthcare environment
• Prior experience working with an adult or elderly population
• 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

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070

• 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.