Pendo Is Hiring An Entitlement Advocate Bilingual

Healthfirst is a leading healthcare provider specializing in Medicare Advantage Plans and various other health services. The Entitlement Advocate role is essential in supporting members with their financial entitlements, promoting independence, and ensuring seamless access to necessary benefits through effective communication and administrative oversight.

Responsibilities

• Handle Calls 📞: Manage inbound and outbound calls with members to address their needs while meeting service level goals.
• Call Screening 🛡️: Screen incoming calls and route them accordingly.
• Call Transfer 🔄: Connect members to appropriate staff or departments.
• Application Assistance ✍️: Support callers with Medicaid Renewal, Medicare Savings Program, and New Medicaid Applications.
• Member Outreach 📧: Reach out to Senior Health Partners, CompleteCare, and Life Improvement Plan members using approved scripts.
• Research Eligibility 💻: Use ePACES and Marx systems to verify Medicaid and Medicare eligibility, exclusions, and exemptions.
• Consult with HRA Staff 🤝: Collaborate with HRA Medicaid personnel and escalate issues to supervisors as needed.
• Documentation 📝: Record all client interactions and outcomes in the database systems.
• Scheduling Appointments 📅: Arrange field visits for Medicaid issues, demographic updates, or restrictions.
• Member Education 🎓: Inform potential members about Senior Health Plans, benefits, eligibility, and enrollment requirements.
• Long Term Care Coordination 🏥: Connect consumers seeking Long Term Care services with the state broker for evaluations.
• Eligibility Assessment 💼: Contact prospects and caregivers through various means to assess Medicaid eligibility.
• Application Processing 📁: Complete and submit Medicaid applications, including renewals and conversions.
• Documentation Collection 📑: Communicate with landlords, employers, banks, and insurers to gather necessary documentation.
• Application Submission 🚀: Submit documentation timely to HRA or local social services departments.
• Tracking & Updates 📊: Monitor application statuses and update systems accordingly.
• Member Advocacy 🤝: Act as a liaison to maximize support and service access for members.
• Data Access & Integrity 🔒: Handle sensitive records responsibly, maintaining confidentiality at all times.
• New Enrollee Support 🎉: Educate new members on CDPAS processes and gather missing forms.
• Recertification Assistance 🔄: Contact members due for Medicaid recertification, conduct home visits, and gather documentation.
• Renewal Management 📅: Complete monthly Medicaid renewal applications efficiently and accurately.
• Documentation & Submission 📑: Collect and submit required documents within deadlines to ensure coverage.
• Monitoring & Compliance ⏱️: Keep track of recertification timelines to prevent lapses in coverage.
• Record Maintenance 📂: Maintain detailed records of coverage status and re-certification in TrucareHTML5 and ePACES systems.
• Reporting 📈: Prepare and submit regular monthly reports.
• Team Collaboration 🤝: Support Care Management, Sales, and Nursing teams with eligibility information for Medicaid and Medicare savings programs.
• Staying Informed 📰: Keep current on Medicaid, Medicare, and HMO laws, sharing updates with the team.
• Training & Meetings 🧑‍🎓: Participate in entitlement-related training and meetings.
• Coordination & Communication 🗣️: Maintain ongoing contact among participants, caregivers, healthcare providers, and support teams to ensure all parties are updated.