- Collaborate with the internal and external teams to develop and maintain the MLTC/MAP disenrollment operational processes and procedures.
- Coordinate the MLTC/MAP enrollment and disenrollment workflow. Troubleshoot cases which require further investigation by Marketing or Maximus to complete the eligibility and enrollment process
- Provide feedback regarding eligibility or enrollment inquiries to Marketing.
- Conduct disenrollment calls to MLTC/MAP members to inquire about disenrollment reason in an attempt to retain members in the program prior to their term effective date based on the State's T file roster.
- Maintain the accuracy of the MLTC/MAP Disenrollment tracking database log and data.
- Maintain 95% or better of accurate data entry rate in the appropriate systems.
- Research and respond to MLTC/MAP transfer/disenrollment inquiries, determines the appropriate follow up action, facilitates issue resolution and gathers supportive documentation.
- Conduct telephonic outreach to program members, primary care physicians and other members of the team regarding plan transfers and disenrollments. Coordinates enrollment/disenrollment/eligibility/transfer activities and processes.
- Proactively troubleshoot and takes initiative to ensure accuracy of outgoing/incoming eligibility information and provides solutions to issues with the data; determines extent and reason for discrepancies.
- Understand NYSDOH and MetroPlusHealth systems and processes in order to verify enrollment and eligibility.
- Execute special projects and other assignments as assigned by MLTC/MAP leadership.
- Develop and maintains internal and external relationships to support management of scope and expectations.
- Adhere to all HIPPA standards and confidentiality requirements.
- Identify issues having an impact on unit operations and communicates them to the management team.
- Identify problems and recommends resolutions to the management team.
- Assist members and applicants in making appointments with the New York Independent Assessor (NYIA) to complete a Community Health Assessments (CHA) and Clinical Appointment (CA) for their Request for Personal Care Services and or CDPAS.
- Add the members or applicants in UAS-NY, uploads completed UAS documents within 24 hours of request or notification and prepares the cases for review and determination of service.
- Give feedback to vendors and report's findings to management team
- Monitor SA files provided by NYIA and follows up on the applicants or members.
- Maintain the list of members in UAS-NY by adding the enrollment or closing enrollments once members are discharged from the program.
- Perform all other duties assigned by supervisor or manager.
- High School graduation or evidence of having satisfactorily passed a High School Equivalency Program
- Excellent data entry skills in a variety of databases.
- Ability to multitask.
- Analytical skills, as well as familiarity with spreadsheets and basic reporting.
- Experience with coordinating data entry with professional, pleasant phone manner simultaneously.
- Computer literacy and excellent written and oral communication skills required.
- Ability to work in a fast-paced environment
- At least 2 years of managed care experience, ideally in a Medicaid managed care setting.
- Understanding of medical terminology.
- Knowledge of medical management functions, experience working in medical management.
- Integrity and Trust
- Customer Service Focus
- Functional/Technical skills
- Excellent communication, written and analytical skills
- Excellent organizational skills
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Description
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The MLTC Enrollment Coordinator is responsible to track and maintain enrollment and disenrollments for program members. The incumbent conducts tracking of disenrollment and transfer requests for MLTC/MAP and works collaboratively with the Assessment Team, Enrollment and Membership (E & M) and Marketing to coordinate enrollment, disenrollment and transfers for members enrolling in MLTC/MAP and those who are disenrolling.
Job Description
