Member Advocate

TruHealth•Ames, IA

5h•Hybrid

About The Position

American Health Advantage is seeking a customer-service oriented leader to support local service areas. This role involves coordinating with Insurance Producers to ensure a seamless transition for newly enrolled members, acting as a primary point of contact for members and their families, and ensuring their needs are met regarding the plan. The Member Advocate will also develop and maintain relationships with key network providers and facilities, conduct monthly meetings with members, and track and manage member status and issues. A critical aspect of this role is ensuring all interactions comply with CMS regulations. The Member Advocate will be responsible for a group of nursing facilities and ensuring all services are carried out for the members within those assigned facilities.

Requirements

Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver.
Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family.
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.
Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans.
Exceptional organizational skills.
Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages.
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 work space allowing for productive office environment.

Nice To Haves

Nursing home experience is preferred.
Insurance or Insurance Customer Service License is preferred; however, not required.

Responsibilities

After member is enrolled, coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.
Once member is enrolled, follow up member 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.
Meet with the member and/or their family at least monthly.
Follow up on any items that the members are dissatisfied with and report to plan accordingly.
Develop and 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 Member Advocate will be responsible for a group of nursing facilities; the Member Advocate is responsible for ensuring that the above services are carried out for each of the members in your assigned group of facilities.
Other responsibilities as assigned.