Healthfirst Enrollment Medicaid Specialist - Spanish in New York, New York

Overview:

Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. We are one of the fastest growing health plans in our area with over 900,000 diverse members and a network of more than 24,000 providers and 3,400 employees.

Our mission is to ensure that our members have superior healthcare and satisfaction; we significantly improve the health and wellness of the New York metropolitan area, all while driving down the costs. Employees shape our company and connect us to our communities. We look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers:

  • Dream Big, Plan Wisely

  • Break Down the Walls

  • Think Critically, Speak Up, Deliver with Pride

  • Inspire Through Trust, Lead By Example

  • Be Unstoppable

Position Summary:

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).

Healthfirst is an Equal Opportunity Employer and does not discriminated against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.

Responsibilities:

  • 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.

  • 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.

  • Complete Medicaid applications for New Enrollees and Renewals as needed.

  • 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.

  • Assist Intake and Care Teams in confirming Medicaid eligibility upon referral by Enrollment or Care Teams.

  • 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.

  • Participate in relevant entitlement training/meetings.

Qualifications:

Minimum Qualifications:

-High School Diploma or GED equivalent.

-Fluent speaking and reading in Spanish and English.

-2 years of work-related experience with Medicaid such as eligibility, screening, application process, review, determining eligibility, recertification or processing.

-Fundamental technical skills so you can solve common serviceable computer problems with an HF.

-Technician telephonically or independently.

-Proficiency in navigating the internet and multi-tasking with multiple software/electronic documentation systems simultaneously (toggling).

-Significant electronic records management capabilities for moving around in a database and entering information.

-Basic usage experience with a corporate email system including calendar functionality, patient health information (PHI) database usage and basic user skills with MS Word and Excel.

-Excellent communication, interpersonal and decision-making skills for frequent interaction with Members and internally with other business units.

Preferred Qualifications:

  • 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.

Requisition ID 2017-15043

Job Locations US-NY-New York

Department Name SHP Entitlement

Equal Opp Statement -

Healthfirst is an Equal Opportunity Employer and does not discriminated against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.

Reasonable accommodation statement -

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 careers@Healthfirst.org or calling 1-800-401-6000. 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.