State Programs Member Engagement Specialist (Facilitated Enrollment)

HealthFirst•New York, NY

About The Position

The MarketPlace Facilitated Enroller is responsible for identifying and educating potential members on all aspects of the plan including new Medicaid, CHP/EP/QHP and answering questions regarding plan’s features and benefits. Responsible for identifying and assisting current members who are due to recertify their healthcare coverage for Medicaid, EP, QHP and CHP by completing member’s annual recertification application including adding on additional eligible family members. Engage in enrollment activities over the phone or in person through onsite coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO’s). Complete and review all applications prior to submitting to NYSOH marketplace. Assist members with selecting a high-quality Primary Care Physician (PCP), order member ID card and make monthly premium payment. This includes using the Healthfirst provider directory via the provider search tool, verifying the correct information in Salesforce/Member 360/OnContact/BizTalk before making any necessary changes based on member’s request. Manage inbound and outbound telephonic enrollment process as a part of the Sales enrollment. On occasion it may be required to perform this function remotely. In such cases, the telecommuting policy will need to be followed. Educate members about digital tools including HF mobile application, Twilio, as well as NowPow Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures. Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually Participate in health-related activities / special events including evening and weekend activities. Events include health fairs, parades, holiday theme events, trade show expos, hospital orientations, provider sponsored events and health related theme events as required based on business needs. Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses and Community Based Organization personnel where enrollment activities are conducted. Develop and strengthen relations in order to generate new opportunities for Healthfirst including new sites and event requisitions. Maintain current working knowledge of product benefits, formulary, sales system functionality, policies and procedures. Demonstrate working knowledge of regulatory and corporate guidelines. Must stay abreast on changes to all lines of business to ensure sales business practices are in compliance with Regulatory, marketing guidelines, and overall corporate policies. Follow the protocol and guidelines provided by the sales auditing department regarding the schedule and site changes. Maintain an adequate supply of marketing materials required to complete the recertification applications as needed. Arrive at scheduled work site, and all activity events in accordance to the departmental attendance policy. Participate in weekly, bi-weekly and monthly staff meetings, one-on-one meetings with management as well as required training sessions. Successfully meet pre and post training, regulatory exams as well as audit requirements. Complete annual NYSOH marketplace recertification requirement, Annual Corporate Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA). Understand and implement the Plan’s policies and procedures for the facilitated enrollment and renewal process Provide information to management on opportunities at current or potential marketing sites. Remain knowledgeable of competitor’s products, marketing practices and keep management informed of such products and practices. Raise any issues / concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

Requirements

Knowledge of Medicaid, Essential Plan, Child Health Plus, Qualified Health Plan, Medicare or any other healthcare product line
Basic knowledge of Microsoft Office (Excel, Word and PowerPoint)
Must have a GED or high school diploma

Nice To Haves

Associate or Bachelor's degree
Bilingual preferred

Responsibilities

Identifying and educating potential members on all aspects of the plan including new Medicaid, CHP/EP/QHP and answering questions regarding plan’s features and benefits.
Identifying and assisting current members who are due to recertify their healthcare coverage for Medicaid, EP, QHP and CHP by completing member’s annual recertification application including adding on additional eligible family members.
Engage in enrollment activities over the phone or in person through onsite coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO’s).
Complete and review all applications prior to submitting to NYSOH marketplace.
Assist members with selecting a high-quality Primary Care Physician (PCP), order member ID card and make monthly premium payment.
Using the Healthfirst provider directory via the provider search tool, verifying the correct information in Salesforce/Member 360/OnContact/BizTalk before making any necessary changes based on member’s request.
Manage inbound and outbound telephonic enrollment process as a part of the Sales enrollment.
Educate members about digital tools including HF mobile application, Twilio, as well as NowPow
Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures.
Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually
Participate in health-related activities / special events including evening and weekend activities.
Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses and Community Based Organization personnel where enrollment activities are conducted.
Maintain current working knowledge of product benefits, formulary, sales system functionality, policies and procedures.
Demonstrate working knowledge of regulatory and corporate guidelines.
Follow the protocol and guidelines provided by the sales auditing department regarding the schedule and site changes.
Maintain an adequate supply of marketing materials required to complete the recertification applications as needed.
Arrive at scheduled work site, and all activity events in accordance to the departmental attendance policy.
Participate in weekly, bi-weekly and monthly staff meetings, one-on-one meetings with management as well as required training sessions.
Successfully meet pre and post training, regulatory exams as well as audit requirements.
Complete annual NYSOH marketplace recertification requirement, Annual Corporate Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA).
Understand and implement the Plan’s policies and procedures for the facilitated enrollment and renewal process
Provide information to management on opportunities at current or potential marketing sites.
Remain knowledgeable of competitor’s products, marketing practices and keep management informed of such products and practices.
Raise any issues / concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.