Member Advocate

Community First Health Plans; San Antonio (TX); On-site; USD 52,000 - 76,000; Full time

Job summary

Community First Health Plans is seeking a SHCN Advocate to assist STAR Kids and STAR+PLUS members, providing education and support to access necessary services and communicating via correspondence as needed. You will work with the Service Coordination team, may facilitate mediation for complaints, help access non-covered services, and ensure HIPAA compliance in all operations.

Bachelor’s degree required with 2+ years in managed care; 5 years may substitute.

Qualifications

• Bachelor’s degree in business, health care or related field; at least two years’ experience in the managed care industry required.
• Five years’ experience in managed care may substitute for college education.
• Complaints and appeals resolution or quality improvement management experience is preferred; working with a special needs population is preferred.

Responsibilities

• Advocate for Special Health Care Needs (SHCN) members, including STAR Kids and STAR+PLUS, to access necessary services; educate and support members.
• Communicate with members via correspondence as needed.
• Collaborate with the Service Coordination team; facilitate mediation for complaints regarding service coordination.
• Assist members in accessing non-covered services through social services or community programs.
• Ensure HIPAA compliance in all operations within Member Services.

Skills

Complaints handling

Quality improvement

Education

Bachelor’s degree in business/health care or related field

Job description

POSITION SUMMARY/RESPONSIBILITIES:
Serve as an advocate to assist and/or represent Special Health Care Needs (SHCN) which includes STAR Kids and STAR+PLUS members on their behalf, in providing education and support to access necessary services. To include communication via correspondence as needed. This individual may work closely with the Service Coordination team and may facilitate mediation in cases of reported complaints regarding service coordination. They may also assist the member in accessing non-covered services, such as those provided in other social service or community programs. Additionally, they may be called upon to participate in other processes as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regard to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE
Bachelor’s degree in business, health care or related field with at least two years’ experience in the managed care industry is required. Minimum of five years’ experience in the managed care industry may be substituted for college education. Complaints and appeals resolution or quality improvement management experience as well as working with special needs population is preferred.