Member Advocate

American Health Partners; Jackson (MS); On-site; USD 42,000 - 68,000; Full time

Job summary

American Health Advantage is seeking a customer-service focused leader to support local service areas as a Member Advocate. You will coordinate with Insurance Producers after enrollment, follow up with members, and serve as a front-line contact for members and care teams.

Responsibilities include maintaining provider relationships, monthly member meetings, and robust reporting while ensuring CMS compliance across facilities in your region.

Qualifications

• Experience in a healthcare delivery setting with elderly patients preferred.
• Exceptional interpersonal and communication skills with the ability to work independently and with a team.
• Ability to travel to facilities within the assigned region and maintain a valid driver’s license.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition and customer service success.
• Follow up with members post-enrollment to answer questions and provide plan updates.
• Act as front-line support with members, facilities, and care teams to meet member and plan needs.
• Develop and maintain relationships with regional providers/facilities to support network adequacy.
• Meet with members and/or families monthly to review needs and progress.
• Report any dissatisfied items to the plan and track issues.
• Maintain reporting on member status, facility calendars, and issue tracking.
• Ensure all interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities; ensure coverage for each member in the assigned facilities.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Customer service

Communication

Organizational skills

Attention to detail

Travel willingness

CMS compliance

Tools

Microsoft Office Suite

Job description

American Health Advantage needs a customer-service focused leader to support local service areas.

Responsibilities

• After member is enrolled, coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.
• Once member is enrolled, follow up member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan;
• Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met;
• Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;
• Meet with the member and/or their family at least monthly;
• Follow up on any items that the members are dissatisfied with and report to plan accordingly;
• Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management;
• Ensure that ALL interactions with the member are compliant with CMS regulations;
• The Member Advocate will be responsible for a group of nursing facilities; the Member Advocate is responsible for ensuring that the above services are carried out for each of the members in your assigned group of facilities;
• Other responsibilities as assigned.

Qualifications/ Requirements

• Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social work or caregiver. Nursing home experience is preferred.
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family;
• Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff;
• Ability to deliver outstanding customer service with a proven track record;
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans
• Exceptional organizational skills
• Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages
• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance;
• Strong proficiency in computer skills in Microsoft Office Suite products;
• Have suitable home work space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.