Initiates the referral and enrollment process for VNS health plan services to achieve desired enrollment goals. Performs outreach to assess eligibility and troubleshoot inquiries related to enrollment issues. Works under general supervision.

$20.98 - $26.23 Hourly

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Provides consumers education on VNS Health plans benefits and eligibility requirements. Reviews and confirms potential enrollees eligibility; collaborates with New York Medicaid Choice (NYMC) in scheduling New York Independent Assessor (NYIA) assessments, including follow up to obtain CFEEC scheduled dates and outcomes as needed.
• Offers assignment of Medicare assistance as needed.
• Responds to inquiries regarding pre-enrollment issues, eligibility and program information to ensure service satisfaction. Works with our internal and external customers to ensure referrals are processed and followed up in a timely manner.
• Participates in outreach to potential enrollees referred via our referral inbox and/or fax. Reviews their eligibility and transfers them to the appropriate program. Schedules the NYIA assessments follow up as needed to obtain NYIA scheduled assessment dates and outcomes as needed.
• Processes daily submissions received internally for enrollment to Maximus via the portal. Maintains member record system with new employee enrollment documents.
• Works collaboratively with various departments and vendors to ensure consumers are enrolled in a timely matter.
• Ensures Auto (State mandatory) enrolled members are uploaded to Share Point for vendor assignment.
• Prepares monthly enrollment report for new enrollees start of care authorizations and care manager assignment.
• Assists in the monitoring and updating of our Health Commerce System case list.
• Provides education on CDPAS process and requirements for members interested in receiving CDPAS services.
• Provides outreach to new enrollees and current members and their PCPs to obtain new or recertification MD Orders for continued CDPAS services.
• Maintains and documents actions taken in our CDPAS membership tracking database and upload completed CDPAS Acknowledgment forms and MD Orders.
• Receives and processes daily Care Management (CM) and Utilization Management (UM) Activities request for vendor assignment. Creates activities for follow up as needed.
• Schedules SCIC and assessment request received via Share Point for Select Health members.
• Conducts daily outreach to potential enrollees to confirm acceptance of hours offered and completion of 3-way transfers calls with the potential enrollee and NYMC prior to the deadline.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• Valid NYS driver's license or NYS non-driver's ID required

Education:

• Associate's Degree in health, human services, other related discipline or the equivalent work experience required

Work Experience:

• Minimum two years experience in customer service required
• Proficient interpersonal, organizational, strong attention to detail, analytical and writing skills required
• Knowledge of Medicaid eligibility requirements required
• Proficiency with personal computers, including MS Excel, Word and Outlook preferred
• Prior experience in Call Center setting preferred
• Fluency in Urdu, Bengali, or Cantonese preferred