Family Health Advocate (Elk Ridge) - Winslow - Family Medicine

El Rio Health•Winslow, AZ

About The Position

The Family Health Advocate performs administrative and processing duties, including determining eligibility for services and assisting with applications in support of Elk Ridge Community Health. The role requires advanced knowledge of community, government, and private social services, agencies, and programs, and serves as an informational resource for clients and staff. The advocate supports recruitment, registration, enrollment, and retention for the ACA Marketplace, AHCCCS, and discount programs, and provides referrals to social services and agencies. Work is performed with intermittent supervision and review; issues involving departures from standard policies, interpretations, or procedures are reviewed with a supervisor or applicable agency representative. The position provides consumers with explanations, information, and enrollment assistance for healthcare programs, including Medicaid (AHCCCS) and the ACA Marketplace. It also supports public access to HEAPlus and ACA Marketplace applications using web-based systems. The advocate conducts research, develops informational summaries, trains and mentors staff on program and regulatory changes, and facilitates annual refresher or recertification training. The role participates in policy and procedure development and recommends operational improvements. The advocate performs Eligibility Assistant duties; maintains required training and certifications, including Certified Application Counselor certification; produces reports and processes operational data; and supports accurate tracking, reporting, and invoicing. The position serves as a liaison for eligibility-related problem-solving and training, presents information to community groups, and participates in community health events. It requires effective customer service, communication, teamwork, confidentiality, compliance with HIPAA and organizational policies, and proficiency with organizational systems and software. The employee is expected to maintain a clean, safe, and hygienic work environment and comply with applicable Joint Commission requirements. Reliable transportation is required to accommodate operational reassignments during the workday. When driving during work hours, the employee must have a valid driver’s license and comply with Arizona vehicle insurance requirements. Reasonable accommodations may be made for individuals with disabilities. Employees must undergo pre-employment drug testing and may be subject to additional testing under applicable policies and regulations.

Requirements

High school diploma or General Education Diploma (GED).
Three years of experience working as a Family Health Advocate, Eligibility Assistant, Outreach Worker, or Certified Application Counselor for the Affordable Care Act.
Upon employment, obtain and maintain certification and licensing as a Certified Application Counselor for the Affordable Care Act.
A current, valid Level I fingerprint clearance card in good standing, or apply for one within seven working days after beginning employment.
Reliable transportation capable of meeting operational reassignments during the workday.
If driving during work hours, a valid driver’s license and compliance with Arizona vehicle insurance requirements.
Undergo drug testing before employment and comply with applicable post-accident, reasonable suspicion, return-to-duty, and follow-up drug and alcohol testing.
Maintain confidentiality and comply with HIPAA, organizational policies, and applicable compliance requirements.

Nice To Haves

Bilingual in English and Spanish, with the ability to speak, read, and write in both languages.
An equivalent combination of education and experience may be considered if directly related to the job’s functions and responsibilities.

Responsibilities

Perform administrative duties and processing, including determining service eligibility and assisting with applications.
Support recruitment, registration, enrollment, and retention for ACA Marketplace, AHCCCS, and discount programs, and refer clients to social services or agencies.
Maintain advanced knowledge of governmental and private healthcare programs, including the Affordable Care Act, Healthy Arizona Plus, and Sliding Fee Scale.
Research healthcare programs and provide informational summaries and training to staff.
Train and mentor new and existing staff on regulatory changes and facilitate annual refresher or recertification training.
Participate in reviewing and developing departmental operational policies and procedures, and recommend process improvements.
Perform all functions, duties, and responsibilities of an Eligibility Assistant.
Provide scheduled and ad hoc reports, including eligibility status lookups, system-generated reports, and outreach and operational data collection.
Maintain required training and certifications for eligibility and enrollment processing and serve as a Certified Application Counselor for the ACA.
Assist consumers with public access and enrollment to HEAPlus and ACA Marketplace applications using web-based systems and software.
Generate and distribute reports, summaries, and correspondence; enter information into program systems, software, and spreadsheets.
Explain eligibility options and requirements and assist consumers with enrollment in Medicaid (AHCCCS), the ACA Marketplace, and other programs.
Respond to calls, emails, and inquiries promptly; provide information and solutions and resolve technical inquiries or complaints.
Communicate effectively with employees, clients, patients, visitors, and representatives; contribute positively to teamwork and the work environment.
Serve as a contact and liaison for internal departments and staff on eligibility-related problem-solving and in-service training.
Facilitate informational presentations to community groups and individuals; conduct public speaking and create materials that meet CMS guidelines and approval.
Participate in community events promoting good health and awareness of healthcare programs and services.
Process operational activity in program systems or spreadsheets to support tracking, reporting, and invoicing of application completion and production.
Maintain proficiency with organizational and agency systems and adapt to system, software, and program changes.
Maintain a clean, safe, and hygienic work environment and comply with Joint Commission Certification standards and reporting requirements.
Represent Elk Ridge Community Health professionally and participate in healthcare activities that support its image and community presence.
Use organizational materials, supplies, and equipment cost-effectively and limit waste.
Accurately document hours worked and ensure timely approval.
Perform other duties as assigned.