Job #: 5650
Title: Intake/Outreach Specialist
The Intake Outreach Specialist will assist in all stages of the onboarding process leading to enrollment in Program of All-inclusive Care for the Elderly (PACE). This includes, but is not limited to, entering information into the database, helping educate prospective participants, uploading documents, follow-up and welcome calls. This person will work closely with referral sources, account managers, clinical intake and provider relations to ensure all and tasks associated with the enrollment process are efficiently completed. The Intake Outreach Specialist is expected to maintain ethical conduct, compliance with state, federal and PACE regulatory requirements, and will be responsible for high quality customer service and satisfaction of all relevant audiences.
Follow up with prospective participants, participants, referral sources and providers to ensure all required enrollment paperwork is completed and uploaded into the system.
Correspond directly with the prospective participants to provide plan education and qualification screening.
Respond to all incoming/outgoing calls, data entry, emails. schedule assessments and mail information to prospective participant.
Enter calls/inquiries into central database for tracking and follow-up and schedule appointments with the prospect/caregiver.
Assist with processing, including delivering and retrieving forms and other documents required, as well as following up with prospective Personal Assistants (PAs) to ensure timely completion of criminal background check requirements.
Enter prospective participant data into the system and update as needed.
Collect and review completeness of all required documents for processing enrollment transactions and reconciliation of enrollment files.
Upload all required forms and other paperwork in the system to ensure accurate and complete documentation on database.
Meet the departmental productivity goals as specified by management for the growth of the company.
Ensure knowledge of PACE program eligibility requirements, services and benefits.
Work closely with all departments to onboard and retain participants.
Evaluate factors unique to each referral including, but not limited to their clinical condition, financial situation, their entitlements status and home support systems.
Use knowledge obtained through the qualification screening to determine which government agencies and team members (entitlements specialists, assessment nurses, etc.) should be assigned to the prospect or caregiver in the next step of enrollment.
Verifiy plan and entitlement status utilizing LDSS/HRA/CMS resources and functions.
Perform provider network verification and other validation of provider participation.
Maintain and generate reports to measure performance and quality of work as set forth.
Participate in implementing workflows and Standard Operating Procedures.
Advise on the development of tools and process improvements to increase quality and departmental operational efficiencies.
Maintain knowledge of all applicable CMS, DOH and PACE-specific guidelines, including organizational and departmental policies and procedures.
Maintain compliance with Medicaid, Medicare and PACE regulations.
All other duties as assigned or requested.
HS Diploma required
Associate Degree preferred
Minimum 2 years work experience in healthcare; preferably with MLTC, MAP, or PACE programs and/or homecare; primarily in intake/enrollment functions.
Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment.
Proficiency with CRM platforms; knowledge of Care Compass strongly preferred.
Knowledge of Maximus, eMedNY, ePACES, CMS MARx and other related HRA/CMS resources and functions.
Proficiency in Microsoft Excel, Word. Outlook and Teams.
Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while meeting targets and projections and performing daily tasks.
Highly organized and flexible to meet submission deadlines. Experience in working independently without significant oversight and or direction from a supervisor.
Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage and services of various public programs a plus.
Familiarity with healthcare organizations and general population dynamics within the greater New York Metropolitan region a plus.
Must have a car and be able to travel throughout service area
Excellent written and oral communication skills a must, familiar with medical technology preferred.
Written and verbal fluency in a secondary language strongly preferred.
Knowledge of PACE program benefits and services and community-based long-term care services to dual eligible and frail adult population preferred.
Positive attitude and outlook with the ability to multi-task in a constantly changing environment
Weekdays, nights and weekends may apply.