PCNA

About the role

The Patient Continuity & Needs Advocate is responsible for helping to cultivate positive patient experience and drive long-term member retention. The incumbent works collaboratively with Membership Growth Consultants (MGCs) and Center Dyads to execute targeted activities to retain membership.

Responsibilities

• Supports Medicaid enrollment; collects demographic documentation and financial data and initiates follow-up procedures when necessary.
• Identifies and shares, with patient and/or family member(s), opportunities to maximize medical benefits and, when necessary, arranges follow-up appointments to ensure appropriate guidance to health services and application timelines.
• Utilizes an Electronic Medical Records (EMR) system to gather and store patient information, respond to questions on behalf of the patient and appropriately and timely document patient issues and resolutions.
• Maintains assigned work queue of patient accounts.
• Completes relevant patient documentation in compliance with all regulatory agencies, including HIPAA.
• Finds creative and compliant ways to engage with our patients and advance our need to have patients call us first.
• Engages with all patients in the lobby, acting as a lobby ambassador, to identify opportunities for referrals, patient ambassadors, and service recovery.
• Responsible for escalating service recovery issues to Center Dyad to ensure timely resolution.
• Leverages Medallia and other patient experience tools to proactively identify members for early service recovery intervention.
• Establishes strong relationships with brokers and agents that have ties with center.
• Leverages MEDALs and other tools to intervene on future disenrollment and disenrolled membership in partnership with Center Dyad.
• Compliantly connects future disenrolls/disenrolled members with agent of record of broker/agent of the day and notifies MGC of record or MGC of the day to reenroll members.
• Identifies and reports on actionable disenrollment and patient engagement trends to inform member retention strategy in collaboration with Center Dyad.
• Performs other duties as assigned and modified at manager’s discretion.

Qualifications

• High School diploma OR GED equivalent required.
• Bachelor's degree preferred OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis.
• A minimum of 3 years work experience required; working with seniors a plus as is a general understanding of Medicare Advantage.

Skills and Abilities

• Fundamental knowledge and understanding of local, state and federal healthcare benefit services and plans.
• Ability to maintain exceptional customer service relationships with healthcare services agencies, patients, providers and peers.
• Dependable and time conscious.
• Flexibility, agility, self-starter, comfortable with frequent changes and innovations.
• Competent level business acuity.
• In-Depth knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques and methods.
• Expert knowledge of member attribution, eligibility and disenrollment process.
• Proven track record establishing and maintaining relationships with seniors.
• Demonstrated skill in customer service and service recovery.
• Knowledge of and experience in working with insurance brokers or agents preferred.
• Detail-oriented and proficiency in Salesforce.
• Excellent written and verbal communication skills.
• Positive attitude and the ability to build trust with internal and external partners.
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
• Spoken and written fluency in English.

Pay

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

Employee Benefits

We offer a comprehensive benefits package including employee assistance programs, wellness initiatives, and opportunities for professional development. Our goal is to provide a supportive environment where our employees can thrive and achieve their goals.