Entitlement Advocate
Healthfirst
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 teams 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 participants 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.
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.
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