Medicaid & Assistance Benefits Navigator

Colonial Group; Nevada; Hybride; USD 52 000 - 70 000; Plein temps

Résumé du poste

ArchWell Health is seeking a Member Financial Counselor to assist members with eligibility determination, enrollment, and recertification for state and federal programs. The role focuses on helping optimize benefits and handling member finance inquiries related to ArchWell Health and other providers.

You will work in a dynamic, data-driven environment, ensuring confidentiality and compliance while supporting cost-sharing programs and program leadership goals.

Qualifications

• Bachelor’s degree preferred or equivalent experience; H.S. diploma or equivalent required.
• Minimum of 3 years experience related to Medicaid and other assistance program eligibility.
• Advanced working knowledge of Medicaid, Medicare Advantage, and other state and federal benefits programs serving seniors.
• Ability to independently guide members through benefits counseling and enrollment activities.

Responsabilités

• Connect with members by phone to assist in completing eligibility paperwork for state and federal programs.
• Provide member support in a contact center environment while meeting productivity, quality, and compliance standards.
• Intake inbound/outbound calls to provider education, resolve benefit concerns, and identify coverage opportunities.
• Proactively identify members eligible for programs to reduce out-of-pocket costs.
• Enter/update data in internal systems to support reporting and program evaluation.
• Coordinate with physicians, nurses, social workers, and others to obtain required information for Medicaid eligibility.

Connaissances

Medicaid knowledge

SNP & assistance programs

Multi-state eligibility

Verbal communication

Organization & written comms

Formation

Bachelor’s degree or equivalent experience

HS diploma or equivalent

Outils

Salesforce

Teams

eCW (eClinicalWorks)

Microsoft Word/Excel/PowerPoint/Outlook

Description du poste

Member Financial Counselor

Job Summary:

The Member Financial Counselor will directly support ArchWell Health members with signing up for state and federal assistance programs to aid members in optimizing benefits they are eligible to receive, in addition to providing support for member finance inquiries for ArchWell Health and non-ArchWell Health medical bills. This role will require technological proficiency and the ability to competently navigate the requirements of the health plans, state and federal assistance programs. This role will have a significant data input component to ensure success of the program is captured and understood across Centers and Markets. This is a professional role where ongoing feedback will be provided and working closely with the Member Financial Counseling leadership is a requirement.

Duties/Responsibilities:

• Connect with members over the phone to assist in completing paperwork for eligibility determination, enrollment, and recertification of state and federal programs; including but not limited to Medicaid, D-SNP, Medicaid and Medicare Savings Program (MSP), Low-Income Subsidy (LIS), Supplemental Nutrition AssistanceProgram(SNAP), and Low Income Home Energy Assistance Program (LIHEAP)
• Provide member support in a contact center environment, meeting established productivity, quality, service, and compliance standards while delivering effective solutions that achieve desired member outcomes, support financial well-being, and enhance the overall member experience.
• Intake/initiate inbound and outbound calls with members to provider education, resolve benefit-related concerns, and identify opportunities for enhanced coverage
• Proactively identify members who are eligible for the programs available to reduce member financial responsibility
• Receiving inbound calls from members during established coverage windows
• Evaluate, research and document financial histories of patients in relation to Medicaid and other state/federal program regulations.
• Enter/update data into various internal and external systems (financial management system, Medical Eligibility Program database, etc.). Inputs necessary data to assist in the necessary capture for reporting.
• Contact physicians, nurses, social workers, employers, banks, etc. to obtain appropriate medical, legal and financial information to complete Medicaid.
• Support ArchWell Health Cost Share Assistance Program
• Exercise and maintain patient confidentiality by complying with all federal, state, and local statues or other agency regulations pertaining to confidentiality and patient’s right to privacy.
• Other related duties as directed by financial program leader.

Required Skills/Abilities:

• Strong working knowledge of Medicaid, SNP and assistance programs, financial counseling practices, eligibility requirements and procedures for multi-state and federal programs
• Strong understanding of state and federal assistance programs, including Medicaid, and managed care plan enrollment and participation requirements, with multi-state Medicaid experience preferred
• Excellent verbal communication and active listening skills, with the ability to conduct effective member conversations, assess needs, provide education and guidance, and influence positive member outcomes
• Ability to partner and communicate with stakeholders in a professional manner
• Strong organization and written communication skills

• Excellent problem-solving skills
• Proven performance results, decision making and judgement
• Strong PC skills with ability to navigate state benefit portals and eligibility systems.
• Must understand medical insurance to be able to discuss and explain balances, deductibles, co-pays, co-insurance. Ability to read and interpret an explanation of benefits (EOB).
• Ability to understand and present data
• Ability to communicate well with all levels of staff, providers, patient referral sources, and members
• Occasional travel required (5-10%)

Minimum Qualifications:

• Bachelor’s degree preferred, or equivalent experience; H.S. diploma or equivalent required
• Minimum of 3 years experience related to Medicaid and other assistance program eligibility required
• Advanced working knowledge of Medicaid, Medicare Advantage, and other state and federal benefits programs serving seniors, including eligibility requirements, enrollment processes, benefit coordination, and plan selection.
• Ability to independently guide members through benefits counseling and enrollment activities.
• Experience with multi-site healthcare delivery organizations desired
• Experience with capitated risk-based reimbursement models strongly preferred
• Proficient in Microsoft Word, Excel, PowerPoint, Outlook
• Ability to learn and work with different software to perform duties of role, including Salesforce, Teams, and eCW (eClinical Works)
• Embodies and serves as a role model of ArchWell Health’s Values:
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.