Category: MM Curator

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New poll shows South Dakota voters are leaning toward expanding Medicaid

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Right now the yeses have it at 62%. Just in time for the PHE wind-down.

 
 

 
 

Medicaid expansion(WITN)

RAPID CITY, S.D. (KEVN) – As the November midterm elections approach, voters are focused on a wide variety of candidates and issues.

However, as one recent poll shows voters could also be looking to expand healthcare access in South Dakota.

A state-wide poll conducted in late August confirmed what officials from the American Cancer Society say they’ve known for a while.

“South Dakotans want to see Medicaid expanded and the majority of voters, 62%, plan to support Amendment D in November,” stated David Benson, Senior State and Local Campaigns Manager for the American Cancer Society.

Amendment D would amend the South Dakota state constitution and provide Medicaid benefits to people ages 18-65 with an income at or below 133% of the federal poverty level.

This would expand access to health care for thousands of South Dakotans.

“Those that may not afford health insurance on their own or they’re not provided health insurance through their provider. So, that is going to help those that are caught in the middle. They either make too much to qualify for Medicaid, traditional Medicaid, and they don’t make enough to get those subsidies to go on the marketplace,” explained Benson.

Benson added there are also financial incentives for states that haven’t expanded their Medicaid yet.

“To keep the tax dollars from going to Washington, to help for healthcare access in states like New York and California. We want to keep those tax dollars here in South Dakota to invest in our healthcare and local economy and Amendment D would do just that,” said Benson.

So why is the American Cancer Society advocating for the expansion of Medicaid?

According to Benson, thousands of South Dakotans are diagnosed with cancer every year, “and having access to healthcare and routine screenings can make the difference between a stage 1 diagnosis or a stage 4 cancer diagnosis. So, what we know from studies, the American Cancer Society has a study that shows newly diagnosed cancer patients have a better survival rate if they live in a state that has expanded Medicaid,” explained Benson.

South Dakota voters have the opportunity to vote on Amendment D this November.

 
 

Clipped from: https://www.blackhillsfox.com/2022/09/14/new-poll-shows-south-dakota-voters-are-leaning-toward-expanding-medicaid/

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HHS Approves 12-Month Extension of Postpartum Medicaid and CHIP Coverage in Indiana and West Virginia

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The Ohio-based MCO will partner with the largest FQHC in Texas as it prepares to make a go for the upcoming RFP.

 
 

 
 

Dayton-based insurance company CareSource announced today it is partnering with a Texas company in a joint venture to serve Medicaid customers in Texas.

CareSource is partnering with Legacy Community Health, a health care system with over 50 locations in the Texas Gulf Coast region, to form CareSource Bayou Health, which plans to apply to serve Texas Medicaid managed care customers.

CareSource Bayou Health will seek contracts to serve members in Harris and Jefferson counties who are part of the State of Texas Access Reform (STAR) Program and Children’s Health Insurance Program (CHIP) when the Texas Health and Human Services Commission releases its request for proposals.

“As a nonprofit organization, we focus on our members and the communities we serve, not shareholders,” said Erhardt Preitauer, president and CEO, CareSource. “With CareSource Bayou Health, we have an opportunity to be an innovative, sustainable partner to the state that will make a lasting difference in the health and well-being of Texans while driving better quality and outcomes.”

Preitauer said the partnership has been in the works for almost a year. They expect to hear from the state of Texas if they will be awarded a contract to offer services to Texas Medicaid customers by late 2023 or early 2024.

“The joint venture between CareSource and Legacy Community Health is unique because it aligns our quality and operational excellence as a managed care organization with their local expertise as Texas’ largest federally qualified health center (FQHC) focused on patient care,” Preitauer said.

CareSource is one of the largest employers the Dayton area, with about 3,000 employees here and approximately 4,500 total.

CareSource, which administers one of the nation’s largest Medicaid managed care plans, already covers 2 million people in Georgia, Indiana, Kentucky, Ohio, and West Virginia. CareSource is also part of a team offering services in Arkansas for people with developmental disabilities.

In August, CareSource announced it would also be serving Medicaid members in Mississippi as part of its partnership with TrueCare, which is owned by nearly 60 Mississippi hospitals and health systems.

CareSource reported an $11.2 billion gross revenue in its 2021 stakeholder report, which was up from its 2019 gross revenue of $10.6 billion. The company’s 2021 stakeholder report said 9.7% of costs went to administrative costs, which was up from 8.3% in the 2020 stakeholder report. In 2019, the company also reported an operating margin of $82.1 million.

 
 

Clipped from: https://www.daytondailynews.com/business/caresource-partners-with-texas-company-in-bid-to-serve-texas-medicaid-members/4EFORHSWLRHR3CCZEU54XYSZ2Q/

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CareSource partners with Texas company in bid to serve Texas Medicaid members

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The Ohio-based MCO will partner with the largest FQHC in Texas.

 
 

 
 

Dayton-based insurance company CareSource announced today it is partnering with a Texas company in a joint venture to serve Medicaid customers in Texas.

CareSource is partnering with Legacy Community Health, a health care system with over 50 locations in the Texas Gulf Coast region, to form CareSource Bayou Health, which plans to apply to serve Texas Medicaid managed care customers.

CareSource Bayou Health will seek contracts to serve members in Harris and Jefferson counties who are part of the State of Texas Access Reform (STAR) Program and Children’s Health Insurance Program (CHIP) when the Texas Health and Human Services Commission releases its request for proposals.

“As a nonprofit organization, we focus on our members and the communities we serve, not shareholders,” said Erhardt Preitauer, president and CEO, CareSource. “With CareSource Bayou Health, we have an opportunity to be an innovative, sustainable partner to the state that will make a lasting difference in the health and well-being of Texans while driving better quality and outcomes.”

Preitauer said the partnership has been in the works for almost a year. They expect to hear from the state of Texas if they will be awarded a contract to offer services to Texas Medicaid customers by late 2023 or early 2024.

“The joint venture between CareSource and Legacy Community Health is unique because it aligns our quality and operational excellence as a managed care organization with their local expertise as Texas’ largest federally qualified health center (FQHC) focused on patient care,” Preitauer said.

CareSource is one of the largest employers the Dayton area, with about 3,000 employees here and approximately 4,500 total.

CareSource, which administers one of the nation’s largest Medicaid managed care plans, already covers 2 million people in Georgia, Indiana, Kentucky, Ohio, and West Virginia. CareSource is also part of a team offering services in Arkansas for people with developmental disabilities.

In August, CareSource announced it would also be serving Medicaid members in Mississippi as part of its partnership with TrueCare, which is owned by nearly 60 Mississippi hospitals and health systems.

CareSource reported an $11.2 billion gross revenue in its 2021 stakeholder report, which was up from its 2019 gross revenue of $10.6 billion. The company’s 2021 stakeholder report said 9.7% of costs went to administrative costs, which was up from 8.3% in the 2020 stakeholder report. In 2019, the company also reported an operating margin of $82.1 million.

 
 

Clipped from: https://www.daytondailynews.com/business/caresource-partners-with-texas-company-in-bid-to-serve-texas-medicaid-members/4EFORHSWLRHR3CCZEU54XYSZ2Q/

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Clawback: Feds say NYC Improperly Billed Medicaid for $84.3M

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A recent audit of NEMT payments has led federal officials to ask for $84M back from NY.

 
 

OIG auditors were unable to determine if an additional $112 million in non-emergency medical transportation claims complied with state and federal requirements.

KEY TAKEAWAYS

The audit examined 4,768,858 payments totaling $269,584,249 (federal share) for NEMT services in 2018 and 2019.

Inspectors found that only 17 of the 100 payments picked in a random sampling complied with state and federal requirements.

Forty-one samples did not comply and auditors could not determine compliance for the remaining 42 samples.

New York officials asked auditors to withdraw the refund request and provide additional documentation for 28 sampled payments.

Federal auditors say New York City should refund $84.3 million to Medicaid after inspectors uncovered widespread noncompliance and sloppy documentation in claims for non-emergency medical transportation.

The audit by the Department of Health and Human Services — Office of the Inspector General also was unable to determine if an additional $112 million in federal funding for NEMT providers complied with state and federal regulations.

The audit examined 4,768,858 payments totaling $269,584,249 (federal share) for NEMT services in 2018 and 2019. Inspectors found that only 17 of the 100 payments picked in a random sampling complied with state and federal requirements. Forty-one samples did not comply and auditors could not determine compliance for the remaining 42 samples.

“On the basis of our sample results, we estimated that New York improperly claimed at least $84,329,893 in Federal Medicaid reimbursement for payments to NEMT providers that did not comply with certain Federal and State requirements,” OIG says. “In addition, we estimated that New York claimed $112,028,279 in Federal Medicaid reimbursement for payments to NEMT providers that may not have complied with certain Federal and State requirements.

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The auditors recommend that New York City refund $84,329,893 to the federal government for the noncompliant payments and further audit the $112,028,279 in questionable payments and refund any money that was inappropriately billed.  

In a written response to the audit, New York Department of Health Acting Executive Deputy Commissioner Kristen M. Proud did not comment on the specific recommendations but asked auditors to withdraw the refund request and provide additional documentation for 28 sampled payments.

“Because of the enormous number of people transitioning transportation managers, and the state’s moral obligation to ensure that there would be no interruptions in the delivery of medical services, the department directed the new transportation managers to accept the level of transportation previously established for each enrollee,” Proud says in a letter to HHS Regional Inspector General Brenda Tierney.

“Neither State statute nor regulation defines a specific period of time for which the written order specifying the appropriate mode is valid,” Proud writes. “Based on the foregoing information and the details below, the Department requests that the repayment request be withdrawn from the audit report.

 
 

Clipped from: https://www.healthleadersmedia.com/revenue-cycle/clawback-feds-say-nyc-improperly-billed-medicaid-843m

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TennCare: Update may have disclosed personal information of Medicaid recipients

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: People in one family may have been able to see data about 1 other family. And some of them are related.

 
 

 
 

 
 

NASHVILLE, Tenn. (WTVF) — Personal information for about 1,700 Medicaid recipients in Tennessee may have been disclosed during an update to a computer system, officials said.

The update may have led to a limited number of people from one household to be able to view some information about individuals in another household that included some of the same people, a statement from TennCare said. The breach happened when a new application listed the name of a person who was already in another household, the statement said.

TennCare quickly determined the scope of the breach, addressed the issue and notified those impacted.

There’s no indication that any information was misused, but the agency is offering 12 months of free identity theft protection services to those affected as a precaution.

TennCare provides health care insurance to 1.7 million Tennesseans.

Clipped from: https://www.newschannel5.com/news/personal-information-for-about-1-700-medicaid-recipients-in-tennessee-may-have-been-disclosed

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Colorado to receive over $1M in Medicaid fraud settlement with optical lens company

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A national lens maker is paying up over kickback allegations in 35 states.

 
 

Colorado Attorney General Attorney General Phil Weiser has announced that Colorado will receive more than $1 million after an optical lens company paid providers kickbacks to refer patients to the company, resulting in the submission of false claims to the Colorado Medicaid program. In the settlement, Essilor, a company that manufactures, markets and distributes optical lenses and equipment used to produce optical lenses, agreed to pay 35 states a total of $22 million plus interest.

 
 

Clipped from: https://www.thechronicle-news.com/2022/09/14/colorado-to-receive-over-1m-in-medicaid-fraud-settlement-with-optical-lens-company/

 
 

Colorado to receive over $1 million in Medicaid fraud settlement with optical lens company

Sept. 8, 2022 – Attorney General Phil Weiser today announced that Colorado will receive more than $1 million after an optical lens company paid providers kickbacks to refer patients to the company, resulting in the submission of false claims to the Colorado Medicaid program.

In the settlement, Essilor, a company that manufactures, markets, and distributes optical lenses and equipment used to produce optical lenses, agreed to pay 35 states a total of $22 million plus interest.

“Kickbacks like those Essilor offered can harm consumers by leaving them with products that are not in their best interest. In this case, the kickbacks affected some of the most vulnerable Coloradans,” Weiser said. “Our office will continue to hold accountable companies that use such underhanded tactics to defraud the state’s Medicaid program.”

The settlement resolves allegations that between Jan. 1, 2011, and Dec. 31, 2016, Essilor knowingly and willfully offered to pay or paid eye care providers, such as optometrists and ophthalmologists, to purchase Essilor products for their patients, including Medicaid beneficiaries. Essilor’s conduct violated the Federal and Colorado’s False Claims Statute and resulted in the submission of false claims to the Colorado Medicaid program.

As part of the settlement, Colorado will receive $1,096,985.36 in restitution and other recoveries.

This settlement arises from two whistleblower lawsuits filed in the United States District Court for the Northern District of Texas and the Eastern District of Pennsylvania. A team from the National Association of Medicaid Fraud Control Units participated in the settlement negotiations on behalf of the states. The team included representatives from the offices of the Attorneys General for the states of California, Colorado, Indiana, Pennsylvania, and Texas.

The Attorney General’s Medicaid Fraud Control Unit is dedicated to protecting the integrity of the system that provides healthcare to the most vulnerable Coloradans. It accomplishes this through the investigation and prosecution of Medicaid provider fraud as well as the investigation and prosecution of the abuse and neglect of Medicaid clients in non-institutional settings as well as the abuse and neglect of patients in institutions that receive Medicaid dollars. To report potential Medicaid fraud, click here or call (720) 508-6696.

 
 

From <https://coag.gov/press-releases/9-8-22/>

 
 

 
 

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A physician’s perspective on Medicaid expansion

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A doc suggests that Medicaid expansion may be a cure worse than the disease.

 
 

Medicaid expansion is one of the critical pillars of the Affordable Care Act (ACA). Since the passage of the ACA, Medicaid expansion has been a Democratic priority, but Republicans are now warming to the idea in some states that have previously resisted expansion. North Carolina is one of 12 states that have not expanded Medicaid, and there are currently proposals in both chambers of the General Assembly proposing such an expansion.

I can offer the front-line view as a physician. I spent over 20 years working as an emergency physician. I continue to see patients, though my professional efforts are now directed toward providing patients with more freedom and choice in their health care decisions. In emergency medicine, I saw the many dysfunctions of the health care system, which are often devastating for the health of patients’. I am acutely aware of the gap between the promises of politicians and the behavior of a complex system in the real world.

The argument favoring expansion is straightforward — more people get health insurance coverage, and the federal government pays for most of it. Opposing views are well-documented, and I refer the reader to the excellent article by Brian Blasé. Briefly, those arguments are 1) Medicaid expansion will impose a burden on state budgets that cannot be sustained without displacing other priorities; 2) at least 20% of current Medicaid spending is due to fraud and waste, which will not improve with expansion and is unconscionable regardless of which taxpayer pocket the money is taken from; 3) expanding Medicaid to able-bodied adults will displace people from private insurance to an inferior product; and 4) those with Medicaid have reduced access to care and receive lower quality care than those with private insurance.  I will focus on this last point here.

In considering Medicaid expansion, it is essential to recognize that insurance coverage is not health care.  On top of the overall shortage of health care providers, a recent survey found that only 53% of physicians accept Medicaid. Studies have documented that this translates into long waits for care. No matter how often I advise a patient to get a primary care physician to help them keep their blood pressure or diabetes under control, many times, they simply cannot get an appointment. Referrals to specialists are often based on hopes and prayers. Red tape, poor payment rates, and bureaucratic inflexibility mean that accepting Medicaid is not worth the hassle for physicians. Expanding Medicaid will not change this dynamic and will likely worsen it.

If having Medicaid improves health, the experience of states that have expanded Medicaid should make it easy to demonstrate that. But studies show that having Medicaid confers no consistent health benefit.  Oregon performed a unique experiment in 2008 when it held a lottery to fill available Medicaid expansion slots. Then, it followed applicants and compared the health measures of those who “won” the lottery to those who did not. The study showed no health benefits to winning the Medicaid lottery.  

Other studies have shown that Medicaid patients with some conditions die at higher rates than those with private insurance and, in some cases, even higher than those without insurance. I am aware of no studies that demonstrate improved care for those on Medicaid relative to private insurance. Those on the front lines of health care understand that quality is a function of the performance of an entire system rather than of an individual. The data tells us that the system does not perform well when Medicaid is the payer. This should not surprise us since it is consistent with our common experience comparing services provided by the government vs. the private sector.

My opposition to Medicaid expansion is shaped by how I see it playing out in the real world for patients.  The fundamental dysfunction of our health care system is that health care is unresponsive to patient needs and just too expensive, no matter who is paying the bill. A functioning market is the only force to make health care (or any service) accessible, affordable, and high-quality. Many options available to state policymakers would increase market forces in health care. Policymakers should consider market-oriented policy solutions rather than doubling down on a solution that has been found lacking in every way that matters. Shouldn’t we expand the things that work rather than a program that has never worked well?

Dr. Sonny Morton is a physician with extensive experience in emergency medicine.

 
 

Clipped from: https://www.carolinajournal.com/opinion/a-physicians-perspective-on-medicaid-expansion/

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Health Payer IT Project Manager (Claims/Medicare/Medicaid) – Apex Systems

 
 

Overview

Health Payer IT Project Manager (Claims/Medicare/Medicaid) Jobs in United States at Apex Systems

Title: Health Payer IT Project Manager (Claims/Medicare/Medicaid)

Company: Apex Systems

Location: United States

Apex Systems has an Immediate Need for multiple (100% Remote) Health Payer IT Project Manager !! These will be estimated 12+ Month “Contract to Possible Permanent Hires” supporting one of our Largest Healthcare Clients on the East Coast. Please see below for all details.

Job Title:Health Payer IT Project Manager

Contract Pay Rate:$50.00 – $55.00 / Hourly Rate(Dependent on Experience)

Location:** 100% Remote **

Contract Type:12 Month “Contract to Possible Permanent Hire”

Requirements

3+ Years of Healthcare Payer Experience ( Understanding what a Claim is, where is goes, who are the providers, how to merge two lines of business)

4+ Years as an official Project Manager

Job Description:

Work with Business and IT Stakeholders to understand the parameters (Scope, Schedule, and Cost) of projects.

Develop a detailed project plan to monitor and track progress

Tracks milestones, deliverables, and change requests.

Manage changes to the project scope, project schedule and project costs using appropriate verification techniques

Report and escalate to management as needed

Perform risk management to minimize project risks

Establish and maintain relationships with third parties/vendors

Create and maintain comprehensive project documentation

Serves as a liaison to communicate information regarding changes, milestones reached, and other pertinent information.

Works with limited guidance and is responsible for applying project management knowledge, skills, tools and techniques to project deliverables, processes, and systems.

Operates within defined parameters using project management methodology.

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Clipped from: https://pharmajobs.me/job/health-payer-it-project-manager-claims-medicare-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Compliance Manager (Indiana – Medicaid) Job in Indianapolis, IN at Elevance Health

 
 

Description
Location – Work From Home

Responsible for managing foundational and strategic compliance responsibilities

Regulator/Customer Relationship Management

  • State regulator and Health Plan communications (ad hoc issue resolution, coordination and support of operational updates, remediation of member and provider concerns, response to fines and sanctions, etc.)
  • State filings review (member and provider communications, vendor subcontracts, reporting, corrective action plans, etc.)
  • Regulator audit support and coordination

Strategic Advisory and Consulting

  • Contract and regulatory subject matter expertise and business strategy consultation, from new business development to operational continuity
  • Contract and regulatory market research requests

Compliance Monitoring and Oversight

  • Compliance risk and issue identification, assessment, and remediation management
  • Development and maintenance of Compliance resources (market comparisons, policies and procedures, etc.)
  • Coordination of Health Plan response to corrective action plans, regulator penalties, and audit findings
  • Marketing and communication oversight
  • Plan compliance training
  • Special Investigations Unit (SIU) support and engagement

Minimum Qualifications

  • Requires a BA/BS and minimum of six years health care, regulatory, ethics, compliance, or privacy experience; or any combination of education and experience, which would provide an equivalent background.
  • Ability to work in a hybrid environment, including from an external office, and at least monthly travel to Anthem’s Indianapolis offices

Preferred Qualifications

  • MS/MBA/JD or professional designation preferred
  • Medicaid or managed care experience preferred
  • Demonstrated record of strong written and oral communication skills
  • Intermediate to advanced level of proficiency using Microsoft Office products (Outlook, Word, Excel, PowerPoint, SharePoint, Teams, OneNote, etc.)

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Clipped from: https://www.ziprecruiter.com/c/Elevance-Health/Job/Compliance-Manager-(Indiana-Medicaid)/-in-Indianapolis,IN?jid=7a78722fffc62f9f&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medicare/Medicaid Membership Representative II, Dallas, Texas

 
 

Large Managed Care Company hiring 15 Medicaid/Medicare Enrollment Representives. Candidates can sit in either Central, Mountain or Pacific Time Zone. 100% remote-based and computer equipment will be provided.

Initial 3-month contract with strong possibility of contract extensions and/or conversion to permanent hire.

Shift times Monday through Friday 8am until 4:30pm in candidate’s time zone.

Target Start Date: 10/3/2022

Title: Membership Representative II

KNOWLEDGE, SKILLS & ABILITIES

• Conducts direct outreach to new Medicare members to provide personal assistance with their new MAPD, DSNP, and MMP plans. Serves as an advocate to ensure members are well informed about plan benefits, provider options and how to use their new plan benefits.

• Serve as the member’s navigator during the onboarding process and address any plan questions and anticipate any issues that may arise. Determine the nature of the member’s needs and interests; inform members of their plan resources and benefits with a focus on the member’s area of interest/needs; and follow up with member to ensure needs are met and member is having a positive plan experience. Develop relationship with member to be the go-to person with any future issues or questions.

• Log all contacts in a database.

• Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed.

• Participates in regular member benefits training with health plan, including the member advocate/engagement role.

JOB FUNCTION:

Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including:

New Member Onboarding, member plan benefits education, and the development/maintenance of Member Materials.

REQUIRED EXPERIENCE:

2 years experience in customer service, consumer advocacy, and/or health care systems. Experience conducting intake, interviews, and/or research of consumer or provider issues. Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager. Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP. (Preferred)

PREFERRED EDUCATION:

Associate’s or Bachelor’s Degree in Social Work, Human Services, or related field.

Job Type: Full-time

Pay: Up to $20.00 per hour

Schedule:
8 hour shift
Monday to Friday

Application Question(s):
Do you live in the Central, Pacific or Mountain Time Zones?

Experience:
Healthcare Customer Service: 2 years (Preferred)
Conducting intake and interviews for healthcare: 1 year (Preferred)
Medicare/Medicaid Managed Care Plans: 2 years (Preferred)

Clipped from: https://jobs.ksnt.com/jobs/medicare-medicaid-membership-representative-ii-dallas-texas/712452937-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic