Member Advocate

American Health Partners; Omaha (NE); On-site; USD 55,000 - 75,000; Full time

Job summary

American Health Advantage in Omaha, NE is seeking a customer-service oriented leader to coordinate member support across local service areas and collaborate with nursing facilities and care teams.

You will oversee enrollment handoffs, answer member questions, ensure CMS compliance, build provider networks, and travel within the region to meet facilities monthly.

Qualifications

• Experience in healthcare delivery with elderly patients; nursing home experience preferred.
• Exceptional interpersonal and listening skills; ability to work independently and in a team.
• Ability to collaborate with nursing, doctors and admin staff across facilities.
• Willingness to travel within assigned region; valid driver’s license and proof of insurance.
• Proficient with Microsoft Office and CMS compliance.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless handoff.
• Follow up with members and families to answer questions about plans.
• Provide front-line support to members, facilities, and care teams.
• Develop and maintain relationships with network providers/facilities across region.
• Meet with members monthly and track satisfaction.
• Ensure all interactions comply with CMS regulations.

Skills

Interpersonal skills

Customer service leadership

CMS regulations knowledge

Strong communication

Travel ability

Microsoft Office Suite

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 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 space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.