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Job Description

Duties and Responsibilities

SHP Renewal Line: (Inbound/Outbound)

Handle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals.

Screen all incoming calls and handles accordingly.

Transfer calls to appropriate staff, unit, or department.

Assist callers requesting assistance with Medicaid Renewal application, Medicare Savings Program application, and New Medicaid Applications.

Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes.

Consult with HRA Medicaid staff as needed and report to the supervisor any need for HRA consultation.

Document all client calls /outcomes in database systems.

Schedule appointments to see members/prospects out in the field to assist with Medicaid Issue or restriction code removals or demographic information changes

Growth (Educate and Assess for Medicaid Eligibility):

Contact prospects or primary caregivers to arrange an interview to assess Medicaid eligibility.

Complete Medicaid applications for New Enrollees and Renewals as needed.

Assist prospects to remove Medicaid restriction codes.

Assist prospects to Convert Market place Medicaid to Community Medicaid.

Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents.

Submit documentation to Human Resource Administration or Local Department of Social Services within a specified timeframe.

Track Medicaid conversions and coverage of all submitted Applications and update status in systems.

Serve as the liaison between all parties and act as Member advocate maximizing the participants support network and obtaining needed services.

Retention (Assist with Renewal of Members Medicaid eligibility):

Responsible for contacting and assisting current Senior Health Partners and Complete Care members who are due to recertify their healthcare coverage for Medicaid.

Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.

Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents.

Submit documentation to Human Resource Administration or Department of Social Services within specified timeframe to assure Medicaid coverage for participant.

Monitor Medicaid re-certification time frames for each active Medicaid member.

Maintain records on every member to show coverage status and timing of re-certification in Salesforce.

Other duties:

Serve as a resource for Medicaid and Medicare savings Programs eligibility.

Keep up to date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and share information with other staff members as appropriate.

Participate in relevant entitlement training/meetings.

Maintain contact between participant/primary support, business office, regarding progress of MA and other entitlement applications.

Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed.

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.

Assists with orientation of new Hires so they understand the model, support enrollment growth and can answer routine questions about the program.

Successfully meet pre and post training and regulatory exams and audit requirements.

Arrive at scheduled work sites, team meetings, training sessions and events in accordance with departmental policy.

Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

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 locations.

Job Qualifications:

Minimum Qualifications:

High school diploma or GED from an accredited institution

Member facing or customer service experience

Be able to work 9am-5:30pm schedule Monday-Friday

Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.

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

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

Bilingual

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** **Qualifications** :

Associate degree from an accredited institution plus 1 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

Telephonic experience with frail adult or elderly population.

A solid understanding of the value of integrated care.

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

Have access to a vehicle with valid proof of insurance and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.

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

Adept at operating within a diverse and multi-cultural work environment

Bilingual

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.