Member Advocate

American Health Partners; Seymour (IN); On-site; USD 42,000 - 62,000; Full time

Job summary

American Health Advantage is seeking a customer-service focused leader to support local service areas and ensure seamless enrollment and ongoing member satisfaction. In this role you will coordinate with care teams, stay in regular contact with members and their families, and build strong relationships with nursing facilities within your region to meet CMS requirements and network needs.

Travel to facilities within the assigned region is expected, and you will maintain calendars, track issues,

Qualifications

• Experience in a healthcare delivery setting with elderly patients; nursing home experience preferred.
• Exceptional interpersonal and communication skills; able to work independently and in a team.
• Ability to coordinate with providers and facilities while complying with CMS regulations.
• Strong organizational skills and ability to manage multiple reports and calendars.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition.
• Follow up with enrolled members to answer questions and provide plan updates.
• Provide front-line support to members, facilities, and care teams as needed.
• Develop and maintain relationships with network providers/facilities in the region.
• Meet with members and/or families at least monthly.
• Follow up on dissatisfaction items and report to plan.
• Manage reporting on member status and facility calendars.
• Ensure all member interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities within assigned region.
• Perform other assigned responsibilities.

Skills

Interpersonal skills

Customer service

Communication skills

Team collaboration

Attention to detail

Willingness to travel

Computer skills (MS Office)

Tools

Microsoft 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 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.