Job details
Job type full-time
Full job description
This role is in dallas, tx
Role summary/purpose
Allyalign health has partnered with several nursing home companies to form an institutional special needs plan (i-snp), which is a form of medicare advantage planAs an i-snp, we will be covering the medical costs of people who are eligible for medicare and who reside in our partner nursing facilitiesProcare advantage is establishing the customer service member advocate roleThis role will include the customer service member advocate responsibilities as defined below.
Responsibilities
This position is considered a work-from-home position as no formal office space/work location is providedThe customer services member advocate conducts the majority of their work throughout the state of texas and is ideally central to dallasTravel to san antonio, beaumont, and houston will be necessary.
The following defines the responsibilities of the customer service member advocate in serving our members:
Respond to and resolve provider, facility and member/responsible party inquiries and issues within established time frames.
Report grievances and complaints per cms regulations and company standards.
As a responsible party or eligible resident indicates interest in the plan, serve as a licensed insurance agent to explain plan benefits, answer questions about the plan, and facilitate a `warm` handoff to a sales agent who will enroll the resident in the plan.
Follow up with members 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.
Visit each assigned facility each calendar quarter.
Provide member rosters monthly to assigned facilities/pcp`s
Conduct quarterly customer service surveys with the member and/or their family; based on the results of the survey, follow up on any items with which the members are dissatisfied.
Support as assigned ad hoc surveys with providers, facilities, nurse practitioners, others; based on the results of the survey, follow up on any items as directed.
Develop/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 customer service member advocate will be responsible for assigned nursing facilities, and 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
The following requirements must be met for a candidate to be hired into this position:
Demonstrated organizational skills.
Two or more years of experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker, caregiver or other related roleNursing home experience is preferred;
Currently hold a license to sell health insurance in texas and be in good standing with the licensing board; or, ability to pass the educational requirements and testing required to obtain the license in texas.
Documented successful sales experience in healthcare market preferred.
Compliant, at all times, with cms regulations regarding medicare advantage plans.
Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback provided by family members.
Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages.
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.
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 workspace allowing for productive office environment.
