State Program Member Engagement Specialist (FE) - Healthfirst
Field, NY
About the Job
+ Identify and educate potential members on all aspects of the plan including answering questions regarding plans features and benefits. Responsible for identifying and assisting current members who are due to recertify their healthcare coverage for Medicaid, EP, QHP and CHP by completing members annual recertification application including adding additional eligible family members.
+ Refer all existing members up for recertification to an onsite Retention Specialist when applicable.
+ Assist members with selecting a Primary Care Physician (PCP) using the Healthfirst provider directory via the provider search tool. This includes verifying the correct PCP in OnContact and making any necessary changes based on members request.
+ Always maintain an adequate Book of Business (BOB), while adhering to the BOB policies and procedures. Complete enrollment activity through the NYSOH marketplace.
+ Meet application goals while adhering to regulatory and state compliance. Enrollment activities include on site coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBOs). All activity entered in Saleslogix (SLX) and PHSP Tracker tool.
+ Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.
+ Review all applications prior to submitting to NYSOH marketplace. Complete a Conflict of Interest (COI) form and Marketplace Facilitated Enroller Disclosure & Applicant Authorization Form (PII) via Docusign for every enrollment encounter. Raise any additional training needs to management.
+ Maintain an adequate supply of renewal materials required to complete the recertification applications.
+ Always maintain and carry Conflict of Interest (COI) forms.
+ Successfully meet pre and post training and regulatory exams and audit requirements.
+ Complete annual NYSOH marketplace recertification requirement and complete Annual Corporate
+ Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA). Understand and implement the Plans policies and procedures for the facilitated enrollment and renewal process.
+ Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses, and Community Based Organization personnel where enrollment activities are conducted. Develop and strengthen relations to generate new opportunities for Healthfirst including new sites and event requisitions.
+ Participate in health-related activities/special events including evening and weekend activities. Events include health fairs, parades, holiday theme events, trade show expos, hospital orientations, provider sponsored events and health related theme events.
+ Arrive at scheduled work site, team meetings, training sessions and events in accordance with departmental policy.
+ Notify the manager and Sales Audit Department when closing a site in accordance with the Sales Operation policy. Participate in weekly, bi-weekly and monthly staff meetings and training including one-on-one meetings with management.
+ Provide information to management on opportunities at current or potential marketing sites. Raise any issues/concerns to management relative to site coverage, competition, training needs and process improvement.
+ Remain knowledgeable of competitors products, marketing practices and keep management informed of such products and practices.
+ Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.
Minimum Qualifications:
+ High School Diploma or GED Equivalent
+ Bilingual as needed
+ Experience in customer service
+ Vehicle with valid proof of insurance depending on territory
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.
+ Refer all existing members up for recertification to an onsite Retention Specialist when applicable.
+ Assist members with selecting a Primary Care Physician (PCP) using the Healthfirst provider directory via the provider search tool. This includes verifying the correct PCP in OnContact and making any necessary changes based on members request.
+ Always maintain an adequate Book of Business (BOB), while adhering to the BOB policies and procedures. Complete enrollment activity through the NYSOH marketplace.
+ Meet application goals while adhering to regulatory and state compliance. Enrollment activities include on site coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBOs). All activity entered in Saleslogix (SLX) and PHSP Tracker tool.
+ Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.
+ Review all applications prior to submitting to NYSOH marketplace. Complete a Conflict of Interest (COI) form and Marketplace Facilitated Enroller Disclosure & Applicant Authorization Form (PII) via Docusign for every enrollment encounter. Raise any additional training needs to management.
+ Maintain an adequate supply of renewal materials required to complete the recertification applications.
+ Always maintain and carry Conflict of Interest (COI) forms.
+ Successfully meet pre and post training and regulatory exams and audit requirements.
+ Complete annual NYSOH marketplace recertification requirement and complete Annual Corporate
+ Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA). Understand and implement the Plans policies and procedures for the facilitated enrollment and renewal process.
+ Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses, and Community Based Organization personnel where enrollment activities are conducted. Develop and strengthen relations to generate new opportunities for Healthfirst including new sites and event requisitions.
+ Participate in health-related activities/special events including evening and weekend activities. Events include health fairs, parades, holiday theme events, trade show expos, hospital orientations, provider sponsored events and health related theme events.
+ Arrive at scheduled work site, team meetings, training sessions and events in accordance with departmental policy.
+ Notify the manager and Sales Audit Department when closing a site in accordance with the Sales Operation policy. Participate in weekly, bi-weekly and monthly staff meetings and training including one-on-one meetings with management.
+ Provide information to management on opportunities at current or potential marketing sites. Raise any issues/concerns to management relative to site coverage, competition, training needs and process improvement.
+ Remain knowledgeable of competitors products, marketing practices and keep management informed of such products and practices.
+ Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.
Minimum Qualifications:
+ High School Diploma or GED Equivalent
+ Bilingual as needed
+ Experience in customer service
+ Vehicle with valid proof of insurance depending on territory
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.
Source : Healthfirst