
•Contacted members or primary caregivers by phone to arrange a telephonic or in person interview to assess Medicaid//Medicare Savings Program eligibility. Ensured all calls are in accordance toapproved scripts•Had full and complete access to patient records and reports as well as to personal/financial profiles anddocuments. •Served as an advocate between all parties maximizing the participant’s support network and obtainingneeded services•Researched ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes•Consulted with Human Resource Administration (HRA)/Local Department of Social Services (LDSS)Medicaid staff as needed and reported to supervisor any need for HRA/LDSS consultation•Tracked the Medicaid/Medicare/MSP status for all members on an ongoing basis until all memberentitlements are gained•Completed Medicaid/MSP application in a timely, organized fashion and assisted participants or primarycaregivers in the completion of the application•Assisted in collecting all required documents for applications•Submited documentation to HRA/LDSS within specified timeframe to assure Medicaid coverage forparticipants•Monitored all applications according to HRA/LDSS/Social Security office/Medicare time frames•Documented all client calls /outcomes in database system and spreadsheets•Responsible for prolonged cycles of work, maintained accurate data to follow up promptly•Prepared monthly reports to Management. •Successfully passed audit exams
Drove membership growth by acquiring new members while also meeting retention targets.•Worked directly with community-based organizations, providers, sales locations, and other sources todevelop self-generated referral channels resulting in increased enrollments.•Identified potential members and designed plans to educate them on the available benefits plans andfeatures that are tailored to the member’s needs and eligibility.•Ensured a superior customer experience through consistent and timely service, follow-up, and planbenefit reviews.•Ensured the right member is in the right plan.•Delivered effective sales presentation to consumer groups, individual prospects and community orprovider partners. •Strictly adhered to all CMS regulations and Healthfirst marketing guidelines.•Ensured all documentation is complete, comprehensive, clear, appropriately filled out includingApplication, Application Confirmation Form, Scope of Appointment and Application Submission Form, andSalesforce.•Provided competitive intelligence to management on any activities Healthfirst’s market competitors areengaging in: e.g. marketing approach, branding campaign, new designs or benefit changes.•Successfully passed audit exams.
•Ensured new hires and existing paraprofessional employees (HHA/PCA) are in compliance with DOHregulations including pre-employment physicals, annual updates, and in-service requirements.•Processed new applicants for employment as well as procure and authenticate documents required foremployment such as I9.•Entered compliance information into software system HHA exchange.•Utilized software system HHA exchange to track ongoing compliance via reporting tools.•Ensured annual performance evaluations/supervisions are being performed for all paraprofessionalemployees.•Coordinated and scheduled on going in-service education for all paraprofessional employees.•Proficient in Microsoft Office Suite and HHA Exchange
Accident & Health Insurance License