Member Advocate Supervisor

Community First Health Plans; San Antonio (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

Community First Health Plans seeks a Supervisor to lead the Member Services Resolution Unit handling STAR, STAR Kids, CHIP, Medicare Advantage, and Commercial members. You will supervise staff and guide resolution of benefits and appeals.

Ensure HIPAA compliance, coordinate with Service Coordination and Care Management, assist with written communications, and provide information to appeal panels and regulators as appropriate. Leadership and training of staff are required.

Qualifications

• Bachelor’s degree in business, health care or related field with at least two years’ experience in the managed care industry.
• Minimum of four years of supervisory work in health care administration; experience may substitute for college education. Complaints and appeals resolution or quality improvement management experience is preferred.

Responsibilities

• Supervise and direct activities of Member Advocates and staff in the Member Services Resolution Unit.
• Ensure HIPAA compliance across operations and coordinate with Service Coordination and Care Management.
• Assist with responses via written correspondence and secure email.
• Provide information to appeal panels, employer groups and/or regulatory agencies as appropriate.

Skills

Supervisory experience

HIPAA compliance

Member services

Communication

Education

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

Job description

POSITION SUMMARY/RESPONSIBILITIES:
Supervise, assist, and direct the activities of Member Advocates and all staff within the Member Services Resolution Unit who represent STAR, STAR Kids, CHIP, Medicare Advantage, and Commercial members in navigating benefits, services, complaint and complaint appeals processes and provide education and support to access care and services. Assist with responses to include communication via written correspondence and secure email, as needed. 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 interdepartmental 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. Work closely with the Service Coordination and Care Management team and facilitate mediation in cases of reported complaints regarding service coordination and care management. Provide information to the appeal panels, employer groups and/or regulatory agencies when appropriate. Assist in training regarding the Complaint and Appeal process.

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 four years of supervisory work in health care administration, managed care, general health care industry may be substituted for college education. Complaints and appeals resolution or quality improvement management experience is preferred.