Member Financial Counselor - MST & PST Time Zone

ArchWell Health•Tucson, AZ

5d•Hybrid

About The Position

The Member Financial Counselor will directly support ArchWell Health members with signing up for state and federal assistance programs to optimize benefits they are eligible to receive. This role will be member facing and require the counselor to travel and work within their assigned and Market to engage with members at centers. This role will require technological proficiency and the ability to competently navigate the requirements of the health plans, state and federal assistance programs. An ideal candidate will have strong attention to detail during significant data input, respond well to ongoing feedback from leadership, and have the ability to communicate effectively with seniors.

Requirements

Strong working knowledge of Medicaid, SNP and assistance programs, financial counseling practices, eligibility requirements and procedures for multi-state and federal programs
Strong understanding of state and federal assistance programs, including Medicaid, and managed care plan enrollment and participation requirements, with multi-state Medicaid experience preferred
Ability to build strong cross-functional relationships to drive projects and initiatives to completion
Ability to partner and communicate with stakeholders in a professional manner
Strong organization and written communication skills
Excellent problem-solving skills
Proven performance results, decision making and judgement
Strong PC skills with ability to navigate state benefit portals and eligibility systems
Must understand medical insurance to be able to discuss and explain balances, deductibles, co-pays, co-insurance.
Ability to read and interpret an explanation of benefits (EOB).
Ability to understand and present data
Ability to communicate well with all levels of staff, providers, patient referral sources, and members
Regular travel will be required within assigned Market (80%)
Bachelor’s degree preferred, or equivalent experience
Valid, active driver’s license with access to a reliable vehicle for travel around the market (80%)
Minimum of three (3) years of relevant experience required; this includes Medicare program experience and Medicare Advantage Special Needs Plan (SNP) eligibility and enrollment experience
Proficient in Microsoft Word, Excel, PowerPoint, Outlook
Ability to learn and work with different software to perform duties of role, including Salesforce, Teams, and EMR systems

Nice To Haves

Multi-state Medicaid experience preferred
Experience with multi-site healthcare delivery organizations desired
Experience with capitated risk-based reimbursement models strongly preferred

Responsibilities

Assist members in completing paperwork for eligibility determination, enrollment, and recertification of state and federal programs, including Medicaid, D-SNP, Medicaid and Medicare Savings Program (MSP), Low-Income Subsidy (LIS), Supplemental Nutrition Assistance Program (SNAP), Low Income Home Energy Assistance Program (LIHEAP), and Lifeline
Evaluate, research and document financial histories of patients in relation to Medicaid and other state/federal program regulations
Enter and update data into various internal and external systems (financial management system, Medical Eligibility Program database, etc.), including data to assist in the necessary capture for reporting
Meet with members and/or guarantor on-site, by appointment or walk-in, or over the phone, to assist with Medicaid, Marketplace or other state/federal application process
Contact providers, nurses, social workers, employers, banks, etc. to obtain appropriate medical, legal and financial information to complete Medicaid
Support ArchWell Health Cost Share Assistance Program for assigned Market
Other related duties as directed by financial program leader
Exercise and maintain patient confidentiality by complying with all federal, state, and local statues or other agency regulations pertaining to confidentiality and patient’s right to privacy
Use strict self-discretion and control in the disclosing of patient information in accordance with company policy and compliance regulations
Make recommendations for process improvements to Financial Counseling leadership