Medicaid Member Advocate

Job ID: J124439
Company: Highmark West Virginia Inc.
Location: Parkersburg, WV, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 14, 2018

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Description

JOB SUMMARY

This job is required by the State and acts as a point of contact to receive Medicaid member inquiries directed to the State.  The incumbent assists members (or their representatives) referred by the State in obtaining care and accessing benefits.

ESSENTIAL RESPONSIBILITIES

  • Assist members (or their representatives), referred by the State, in obtaining care and accessing benefits.  This requires intense coordination with business partners, vendors, the State, and members (or their representatives).
  • Work with members, providers and the member’s case managers as needed to:  Assist the member in obtaining care, including scheduling appointments; advising, enrolling in and accessing benefits; and assisting the member with the Contractor’s Grievance and Appeals process. Follow-through required to ensure all assignments are completed.
  • Participate in the Appeal process and support the member and member representative during the Appeal.  If the member or member representative attends the Appeal meeting in person, the incumbent shall attend the Appeal meeting in person. 
  • Maintain full and complete records of all activities performed on behalf of a member.
  • Serve as the dedicated Member Advocate as required by the State fulfilling all required responsibilities thoroughly, completely, and timely.
  • Other duties as assigned or requested.

EDUCATION

Required

  • High School Diploma/GED

Substitutions

  • Experience in the healthcare industry (hospital clinical operations/management, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant knowledge of various care delivery models

Preferred

  • None

EXPERIENCE

Required

  • 2 years of experience in health care, such as insurance customer service or physician's office, preferably working with low-income populations

Preferred

  • Health insurance customer service experience
  • Experience working with Medicaid members

SKILLS

  • Strong customer service orientation
  • Cultural competency
  • Organization and documentation skills

LICENSES OR CERTIFICATIONS

Required

  • None

Preferred

  • None

TRAVEL REQUIREMENT

0%  - 25%
 

LANGUAGE REQUIREMENT (Other than English)?  
None

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
 

Position Type

Office-Based

Office-Based Positions

An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly

Does Not Apply

Travels regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

No

Lifting: up to 10 pounds

Rarely

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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