Member Advocate

American Health Communities; Lubbock (TX); On-site; USD 45,000 - 75,000; Full time

Job summary

American Health Advantage seeks a customer-service focused leader to support local service areas and ensure strong member advocacy. You will coordinate with Insurance Producers and act as the primary contact for enrolled members and their families to resolve plan questions and provide periodic plan updates.

As front-line support, you will work with member facilities and the care team to meet member needs, develop regional provider relationships, and maintain monthly member meetings while

Qualifications

• Experience in healthcare delivery with elderly patients.
• Excellent interpersonal and communication skills.
• Ability to work independently and in a team.
• CMS regulations compliance experience.
• Willingness to travel to facilities in the region.
• Nursing home experience preferred.
• Driver license is required.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure a seamless transition and accurate records.
• Follow up with members and families to answer questions and provide updates on the plan.
• Act as front-line support with the member, facility, and care team to meet member needs and CMS requirements.
• Develop and maintain relationships with key network providers/facilities within the region.
• Meet with the member and/or family at least monthly.
• Ensure that all interactions with the member are compliant with CMS regulations.
• Develop and maintain reporting on member status, facility calendars, and issues tracking.
• Oversee a group of nursing facilities to ensure service delivery for all members in the assigned group.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Customer service

Written communication

Verbal communication

Active listening

Team collaboration

Organizational skills

Travel willingness

Education

Associates or better

Tools

MS Office

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 worker 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 spaceallowing for productive office environment.

Insurance or Insurance Customer Service License is preferred; however, not required.

Qualifications

Education

Preferred

Associates or better.

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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