Description and Requirements

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 with  approved Healthfirst scriptsHas full and complete access to patient records and reports as well as to personal/financial profiles and documents, always calling for the utmost integrityServes as an advocate between all parties maximizing the participant’s support network and obtaining needed servicesResearch ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codesConsult with Human Resource Administration (HRA)/Local Department of Social Services (LDSS) Medicaid staff as needed and report to supervisor any need for HRA//DSS consultationTrack the Medicaid/Medicare/MSP status for all members on an ongoing basis until all member entitlements are gainedCompletes Medicaid/MSP application in a timely, organized fashion and assists participant or primary caregiver in the completion of the applicationAssists in collecting all required documents for applicationsSubmit documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage for participantMonitor all applications according to HRA/LDSS/Social Security office/Medicare time framesDocuments all client calls /outcomes in database system and spreadsheetsResponsible for prolonged cycles of work, must maintain accurate data and be able to present it and follow up promptlyPrepare/submit monthly reports to Management

Ongoing Knowledge & Support:

Keep up to date on changes in Medicaid/Medicare/HMO laws and shares information with other Team members as appropriateParticipate in relevant entitlement training/meetingsEngage in mastering the divisions impact on Healthfirst and its membersContribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projectsMaintain the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contactsAssists with orientation of new Hires so they understand the model, support enrollment growth and can answer routine questions about the program.Handle other duties as assigned with the occasional need to work weekends, additional hours before or after shift schedule and/or from other HF site locationsExperience managing member information or appointments in a shared network environment using paperless database modules

Minimum Qualifications:

Minimum Education: High School diploma or GEDPrior experience with Medicaid //Medicare//Medicare Savings ProgramExperience in inbound and outbound call center within a healthcare environmentHave access to a vehicle and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau CountyWell organized, detail oriented, and able to adapt to procedural and other business information changesStrong data entry skills, must be able to maintain monthly spreadsheets for tracking and statistical purposes

Preferred Qualifications:

Associate degree from an accredited institutionPrior experience working with the frail adult or elderly populationA solid understanding of the value of integrated careExperience in health insurance, home care environment, acute, sub-acute, long-term care (LTC) setting or managed-long term care (MLTC)

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.