Healthfirst New York Jobs

Duties and Responsibilities

• Handling inbound and outbound calls to and from customers to address their needs while adhering to internal Service Levels standards.

• Creates and/or follow ups for up to 90 days on Long-Term Care (LTC) Leads and Opportunities entered in Salesforce.

• Create and/or follow ups for up to 30 days on Personal Care services requests for the Mainstream population in Salesforce.

• Answer all calls or complete outbound calls according to approved scripts.

• Searches ePACEs for Medicaid eligibility, exclusion, and exemption codes.

• Searches in Marx (CMS) for Medicare eligibility, enrollments, and special elections.

• Achieves daily, weekly, and monthly growth goals.

• Handle all calls to maximize productivity and optimal operational efficiency.

• Connects consumers seeking personal care/long term care services with the State broker to complete the initial evaluation.

• Schedules all field and tele video conference appointments for SHP Intake Nurses in Salesforce.

• Schedules all field and tele video conference appointments for HF CompleteCare Specialist and Intake Nurses in Salesforce.

• Schedules Entitlement Advocates appointments for SHP and HF Complete Care prospective members with a Medicaid coverage issue or restriction.

• Schedules Clinical Assessors to complete Community Health Assessments for Mainstream/HARP members requesting Personal Care Services at home.

• Documents all incoming/outbound calls under call tracking in Salesforce

• Documents all outcomes in pre-enrollment database system.

• Documents all special instructions in Salesforce

• Coordinates the preparation of fulfillment kits / brochures to prospective members or those requesting addition information in a timely manner.

• Troubleshoots and follows up on LTC enrollment rejections.

• Handles other duties as assigned with the occasional need to work weekends, additional hours before or after shift scheduled.

• Engage in mastering the Divisions impact on all Healthfirst Plans and its members.

• Ability to create a positive impression during first contact with prospective members by setting the tone and being able to immediately demonstrate product knowledge and credibility with the goal of maximizing the number of scheduled appointments to achieve daily, weekly, and monthly goals. Persuasive and able to establish trust.

• Additional duties as assigned.

Minimum Qualifications

• High school diploma or GED.

• Fluency in reading and speaking English and additional language.

• Member / Customer Service experience.

• Availability to work for 8 hours shift, based on business needs, within our hours of operations: Monday Friday 8:00 AM 8:00 PM and Saturdays 10:00 AM 6:30 PM. 8:00 AM to 8:00 PM Monday -Sunday during open enrollment (October March). Initial Training schedule may vary from permanent assigned schedule.

• Occasional overtime.

• Capability to work in a remote environment with reliable internet connection.

• Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint

• Organized and multi-tasking capabilities and detail oriented.

• Understanding of and sensitivity to cultural differences and needs of the community are essential.

• Adept at working in an environment with fast-past changing priorities including high stress while achieving quota expectations.

• Available to communicate / engage with your leaders via Virtual platforms (emails, MS Teams and others)

• Must have a valid NYS State ID or Driver's License

Preferred Qualifications

• Work experience within the healthcare industry

• Experience with Medicare or Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS) and/or Federal Employee Program (FEP). (Preferred)

• Associate degree or higher from an accredited institution.

• Extensive work experience including inbound and outbound call center with telemarketing responsibilities within a healthcare environment.

• Healthfirst product knowledge of Complete Care, Senior Health Partners (SHP) or managed long-term care.

• Prior experience engaging / communicating with the frail adult or elderly population.

• A solid understanding of the value of integrated care.

• Experience in health insurance, home care environment, acute, sub-acute, long-term care (LTC) setting or managed-long term care (MLTCP).

• Experience managing member information or appointments in a shared network environment using paperless database modules.

• Adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Southeast Asian and others.

• Ability to maintain a calm, neutral disposition while managing many details in a distracting environment

License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.