The Enrollment Medicaid Specialists provides Healthfirst’ s Medicare Advantage Plan (MAP), Senior Health Partners’ (SHP) Managed Long|Term Care (MLTCP), FIDA and Nursing Home members and families with assessment and interventions related to enrollment processing of qualified, eligible candidates for enrollment and obtaining and retaining of financial entitlements for which they are eligible. This enables members to maintain the highest level of independence both at home and within their communities.
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 CCMS (CareEnhance Clinical Management Software), Sunguard MACESS Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word, Excel and Outlook). Ours is a paperless work environment requiring daily hands|on administration of multiple proprietary and packaged electronic databases including security requirement tools such as encryption. These systems include but are not limited to CCMS (CareEnhance Clinical Management Software), Sunguard MACESS Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word, Excel and Outlook).
Conducts individual pre-enrollment screening:
Meets with individuals who may qualify for enrollment in Senior Health Partners or Montefiore MSO throughout the 5 boroughs, Westchester and Nassau County. Explains the program features, benefits and commitments, including explanation of the Member Handbook.
-Identifies obstacles and opportunities for enrollment:
Obtains feedback from referral sources and prospective enrollees.
Stimulates word-of-mouth referrals from participants, prospects and their families.
Assists with orientation of new Enrollment Specialists at Senior Health Partners so they understand the model, support enrollment growth and are able to answer routine questions about the program.
-Participates in the care team for continuous performance improvement:
Facilitates problem-solving for performance improvement.
Contributes to the team’s efforts to every enrollee with respect, courtesy and fairness in a way that provides superior customer service.
Complete Medicaid applications for New Enrollees and Renewals as needed.
Contact member or primary caregiver in person, by phone or letter to arrange an interview to assess Medicaid eligibility.
Complete Medicaid application in a timely, organized fashion and assists participant or primary caregiver in the completion of the Medicaid application.
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 (HRA) within specified time-frame to assure Medicaid coverage for participant.
Track the Medicaid status for all new enrollees.
Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times.
Assist Intake and Care Teams in confirming Medicaid eligibility upon referral by Enrollment or Care Teams.
Researches Medicaid through www.eMEDNY.org and ePACES.
Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation.
Monitor Medicaid re-certification time frames for each active Medicaid member.
Contact members two months prior to MA expiration date.
Ensure completion of re-certification application.
Maintain records on every member to show coverage status and timing of re-certification in CCMS Management Information System (MIS).
Document status of Medicaid and entitlement coverage in designated CCMS Management Information System (MIS).
Prepare/submit monthly reports.
Serve as a resource to Care Management Teams for Medicaid and other Medicare savings Programs.
Keep up-to-date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and shares information with other Social Work and Care Team members as appropriate.
Participate in relevant entitlement training/meetings.
Serve as the liaison between all parties and acts as Member advocate maximizing the participant’s support network and obtaining needed services.
Maintain contact between participant/primary support, business office, social worker and enrollment specialist to keep parties updated regarding progress of MA and other entitlement applications.
Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed.
Engage in mastering the Divisions impact on HF/SHP and its Members.
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.
Handle other duties as assigned.
1 year of job specific industry experience in Long-Term (LT) or Managed Long-Term Plan (MLTCP).
– Associates degree or 60 college credits and 1 year of work-related and job specific experience.
-Technical skills in e-faxing, electronic archiving or encryption.
-Knowledge of current community health practices for the frail adult population and/or cognitively impaired seniors including the values offered with integrated care.
-Experienced in one or more of the following additional areas: health insurance, home care environment, acute or sub-acute.
-Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), and Federal Employee Program (FEP).
-Experience training or coaching junior staff in daily department operational procedures and product knowledge.
-Valid Driver’s License
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