Sr Retention Advocate - Must have a car, New York, NY

Created 01/13/2022
Reference 1145439
Job type Full Time
State NY
City New York
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 to approved Healthfirst scripts
  • Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, always calling for the utmost integrity
  • Serves as an advocate between all parties maximizing the participant's support network and obtaining needed services
  • Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes
  • Consult 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
  • Track the Medicaid/Medicare/MSP status for all members on an ongoing basis until all member entitlements are gained
  • Completes Medicaid/MSP application in a timely, organized fashion and assists participant or primary caregiver in the completion of the application
  • Assists in collecting all required documents for applications
  • Submit documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage for participant
  • Monitor all applications according to HRA/LDSS/Social Security office/Medicare time frames
  • Documents all client calls /outcomes in database system and spreadsheets
  • Responsible for prolonged cycles of work, must maintain accurate data and be able to present it and follow up promptly
  • Prepare/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 appropriate
  • Participate in relevant entitlement training/meetings
  • Engage in mastering the divisions impact on Healthfirst 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
  • Assists 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 locations
  • Experience managing member information or appointments in a shared network environment using paperless database modules

Minimum Qualifications:
  • High School diploma or GED
  • Prior experience with Medicaid /Medicare/Medicare Savings Program
  • Experience in inbound and outbound call center within a healthcare environment
  • Have access to a vehicle and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
  • Well organized, detail oriented, and bale to adapt to procedural and other business information changes
  • Strong data entry skills, must be able to maintain monthly spreadsheets for tracking and statistical purposes

Preferred Qualifications:
  • Associate degree from an accredited institution
  • Prior experience working with the 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 (LTC) setting or managed-long term care (MLTC)

Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to an environment where our employees are fully vaccinated against COVID-19. As a prospective new team member, you must be fully vaccinated with a CDC/FDA approved COVID-19 shot(s) to work in our offices. If you are selected to interview for this role, we will explain our vaccination policy in further detail and ensure you are comfortable moving forward with this company policy.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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.

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 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 Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" 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, 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.
Employer Healthfirst Inc.

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