Healthfirst Is Hiring An Entitlement Advocate Bilingual

Unlock the potential of our members with personalized support in accessing their entitled benefits, ensuring they maintain independence and community engagement. The Entitlement Advocate plays a vital role in guiding members and prospects through the complexities of Medicaid, Medicare, and related programs, fostering better health outcomes and quality of life.

✨ About the Role: Entitlement Advocate

The Entitlement Advocate is responsible for assisting Healthfirst members across Medicare Advantage Plans (MAP), Managed Long-Term Care (MLTC), Dual Eligible Medicare Plans, and Nursing Home populations. This role ensures members and prospects obtain and retain the financial entitlements they are eligible for, promoting independence and community involvement.

Working under the supervision of the Entitlement Manager and Team Leads, the advocate efficiently manages multiple tasks in a fast-paced, proactive environment, frequently communicating complex information through electronic documentation tools. This paperless setting involves daily management of sensitive Patient Health Information within secure electronic databases, including encryption tools.

🔹 Duties & Responsibilities

• Customer Communication: Handle inbound and outbound calls, addressing member needs while meeting service level goals.
• Call Screening & Transfers: Screen and route incoming calls appropriately.
• Application Assistance: Support callers with Medicaid Renewal, Medicare Savings Program, and new Medicaid applications.
• Member Outreach: Engage with Senior Health Partners, CompleteCare, and Life Improvement Plan members per approved scripts.
• Eligibility Research: Use ePACES and Marx systems to verify Medicaid and Medicare eligibility, exclusion, and exemption codes.
• Collaboration: Consult with HRA Medicaid staff as needed, reporting to supervisors on necessary HRA interactions.
• Documentation: Record all client interactions and outcomes within database systems.
• Field Appointments: Schedule visits to assist members/prospects with Medicaid issues, demographic updates, and issue removals.

🩺 Growth – Educate & Assess Medicaid Eligibility

• Educate potential members on benefits and enrollment requirements for Senior Health Partners and Long Term Care plans.
• Connect individuals seeking Long Term Care services to the state broker for initial evaluations.
• Arrange interviews for Medicaid eligibility assessments via in-person visits, calls, or letters.
• Complete Medicaid applications for new enrollees and renewals.
• Assist in removing Medicaid restriction codes and converting Marketplace Medicaid to Community Medicaid.
• Gather necessary documents from landlords, employers, banks, and insurers by calls, written correspondence, or in-person visits.
• Submit documentation to HRA or local social services within required deadlines.
• Track application submissions and status updates in internal systems.
• Act as a dedicated advocate, maximizing participants' support networks to secure essential services, maintaining full access to sensitive records with utmost integrity.
• Support the Welcome Enrollment Team by educating new enrollees on CDPAS (Consumer Directed Personal Assistance Services).

🔄 Retention – Member Medicaid Recertification Support

• Proactively contact members nearing Medicaid expiration to facilitate recertification.
• Conduct home visits or meetings as needed to gather documentation and complete renewal applications.
• Organize and submit renewal applications promptly to ensure continuous coverage.
• Monitor re-certification timelines, maintain detailed records, and update systems accordingly.
• Prepare and submit monthly reports on recertification statuses.

🛠️ Other Responsibilities

• Serve as a resource for Care Management, Sales, and Nursing Teams regarding Medicaid and Medicare savings programs.
• Stay informed on updates related to Medicaid, Medicare, and HMO laws, sharing insights with team members.
• Participate in ongoing training and entitlement-related meetings.
• Maintain effective communication with primary supports, healthcare providers, social workers, and enrollment teams to keep everyone updated.
• Collaborate with Medicaid staff and other stakeholders to ensure timely and accurate application processing.
• Engage actively in understanding the divisions' impact on Healthfirst and its members.