Field Entitlement Advocate

Healthfirst; West View (Allegheny County); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Healthfirst seeks an Entitlement Advocate to support MAP, LTC, and Medicare plans, helping members obtain and retain entitlements while maintaining independence. Under the Entitlement Manager, you will navigate multiple databases and coordinate with teams to ensure long-term care and community-based support.

Responsibilities include handling calls, assisting with Medicaid renewals and enrollments, educating members on eligibility, and documenting outcomes.

Qualifications

• High school diploma or GED from an accredited institution.
• Customer service experience in a member-facing role.
• Availability to work 9:00–17:30.
• Willing to travel across the 5 boroughs and surrounding counties.
• Hybrid schedule (remote/office/field).
• Tech-savvy with Microsoft Office (Outlook, Excel, Word, PowerPoint).
• Bilingual.
• Ability to communicate with leadership via Zoom or Teams and in person.

Responsibilities

• Handle inbound and outbound calls to address member needs while meeting SLAs.
• Assist callers with Medicaid renewal, Medicare Savings Program, and new Medicaid applications.
• Educate and assess for Medicaid eligibility and enrollments.
• Coordinate with state agencies and document outcomes in systems.
• Prepare monthly reports and manage required documentation.
• Serve as liaison linking members with field staff and brokers.

Skills

Customer service

Bilingual

Communication

Travel ability

Education

High school diploma or GED

Associate degree

Tools

TrucareHTML5

Salesforce

ePACES

RightFax

Adobe Acrobat

Microsoft Office

Job description

The Entitlement Advocate provides Healthfirst’s Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of financial entitlements for which they are eligible. This enables prospects and members to maintain the highest level of independence both at home and within their communities. Working under the direction of the Entitlement Manager and Team Leads, maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities. 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 databases and security requirement tools such as encryption. These systems include but are not limited to TrucareHTML5 , Sunguard MACESS Service Module (electronic archiving), Salesforce, ePACES, RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office Suite (such as Word, Excel and Outlook), Interaction Client, Jabber, etc.

Duties and Responsibilities SHP Renewal Line: (Inbound/Outbound)

Handle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals. Screen all incoming calls and handles accordingly. Transfer calls to appropriate staff, unit, or department. Assist callers requesting assistance with Medicaid Renewal application, Medicare Savings Program application, and New Medicaid Applications. Outreach Senior Health Partners, CompleteCare, and Life Improvement Plan members according to approved scripts. Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes. Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation. Document all client calls /outcomes in database systems. Schedule appointments to see members/prospects out in the field to assist with Medicaid Issue or restriction code removals or demographic information changes Growth (Educate and Assess for Medicaid Eligibility): Educate potential members on Senior Health Partners, Long term care plan benefits answering questions regarding plan’s features and benefits as well as go through eligibility and requirement for enrollment. Transfer and connect consumers seeking Long Term Care services with the state broker to complete initial evaluation (New York Independent Assessor). Contact prospects or primary caregiver in person (home or Community Office visit), by phone or letter to arrange an interview to assess Medicaid eligibility. Complete Medicaid applications for New Enrollees and Renewals as needed. Assist prospects to remove Medicaid restriction codes. Assist prospects to Convert Market place Medicaid to Community Medicaid. 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 or Local Department of Social Services within specified timeframe. Track Medicaid conversions and coverage of all submitted Applications and update status in systems. Serve as the liaison between all parties and acts as Member advocate maximizing the participant’s support network and obtaining needed services. Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times. Serve as a resource for Welcome Enrollment Team, Educating new Enrollees on CDPAS information and forms. Serves as a resource to gather missing EAA forms for Nurse Accepted Enrollments (field pick up).

Retention (Assist with Renewal of Members Medicaid eligibility): Responsible for contacting and assisting current senior Health Partners and Complete Care members who are due to recertify their healthcare coverage for Medicaid. Contact Senior Health Partners or Complete Care members two months prior to Medicaid expiration date. Conduct home visits and other appointments as needed to complete the application and obtain all required documentation. Complete Monthly Medicaid renewal applications in a timely, organized fashion. 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 or Department of Social Services within specified timeframe to assure Medicaid coverage for participant. Monitor Medicaid re-certification time frames for each active Medicaid member. Ensure Human Resource Administration and/or Department of Social Services receives the renewal applications and completes re-certification of eligibility timely. Maintain records on every member to show coverage status and timing of re-certification in TrucareHTML5 by opening assessments 2 months prior to renewal due date and closing them out when a member is fully recertified in ePACES. Prepare/submit monthly reports.

Job Qualifications

• High school diploma or GED from an accredited institution
• Member facing or customer service experience
• Be able to work 9am-5:30pm schedule
• Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.
• Capability to work in a Hybrid Schedule (remote/office/field)
• Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint.
• Bilingual
• Be able to communicate and engage with the leadership team on virtual platforms such as Zoom or Microsoft Teams chat as well as in person

Preferred

• Associate degree from an accredited institution plus 1 year of related work experience including inbound and outbound call center within a healthcare environment.
• Work experience within the healthcare industry Prior experience with Medicaid /Medicare Savings Program Telephonic experience with frail adult or elderly population.
• A solid understanding of the value of integrated care.
• Experience in health insurance, home care environment, acute, sub-acute, long-term care setting, or managed-long term care Have access to a vehicle with valid proof of insurance and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.
• Experience managing member information or appointments in a shared network environment using paperless database modules Adept at operating within a multi-cultural work environment Bilingual

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. 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 [e-mail] or calling 212-519-1798 . 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 HF Management Services, LLC will be reviewed at the e‑mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960 All Other Locations (within approved locations): $42,200 - $62,400

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.