Medicaid Outreach and Retention Representative

Now hiring a Medicaid Outreach and Retention Representative

Responsible for statewide education outreach acquisition and retention of Presbyterian Medicaid members and acquisition of prospects. Represents Presbyterian in the community; networks develops and manages relationships with key government and community advocate agencies. Creates and conducts educational presentations for internal and external customers; response to escalated inquiries requiring research and resolution of complex issues. Applies CMS NCQA and State of New Mexico regulations and established PHP approved policies procedures and guidelines in all customer contacts member initiatives and communication materials. Responsible for submission process of time-sensitive contracts from external entities to Legal Services. Requires excellent communication analytic organization and time management skills.

How you belong matters here.

We value our employees differences and find strength in the diversity of our team and community.

At Presbyterian its not just what we do that matters. Its how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.

• Bachelors degree preferred; Associates degree or 3 years experience in lieu of degree.
• Demonstrated abilities through education and/or work experience. Bilingual Spanish-speaking reading and writing preferred.
• Speak and understand one or more of New Mexico Native American languages (Tribes Nations or Pueblos) if applicable
• Obtain New Mexico State Presumptive Eligibility/ Medicaid On-site Application Assistance PE/MOSAA certification required or obtained within 90 days of hire. 2-3 years experience in managed care organization preferably in Medicaid Plans and other dual-eligible or long-term care market products and programs.
• And/or 3-5 years customer service experience in health insurance healthcare retention community outreach or marketing.
• Additionally healthcare claims processing provider network or other background in research and resolution of complex issues experience preferred.
• Excellent public speaking and presentation skills; demonstrated ability to communicate effectively in person by phone and in writing to people with different cultural and socio-economic backgrounds.
• Excellent PC skills; MS Office/Windows required; database experience preferred; experience with integrated data management systems. Ability to travel within the State of New Mexico based on assigned territory and departmental need.
• Must be able to lift 35 to 70 pounds packing loading event set up and take down regularly; frequent travel and occasional overnight stays. Must have own vehicle a valid NM drivers license and maintain a good driving record.
• Must provide own transportation and be able to travel.
  If/when applicable - Working knowledge of Medicare Advantage program. Other duties as assigned

• Organizes facilitates and participates in community outreach and customer education events effectively communicating program attributes plan benefits services available product changes and regulatory requirements to a variety of audiences resulting in prospects successful application to the appropriate program.
• Secures supplies and marketing materials used in outreach and enrollment activities. Projects positive organizational image to the public. Prepares education materials to include handouts workbooks evaluation forms and visual aids; reviews materials for compliance and quality.
• Educates members on a variety of governmental and commercial products; assists prospects and members with enrollment in Medicaid. Must be able to understand both business and member views in order to communicate necessary information so that it meets both business needs and member experience requirements.
• Researches compiles analyzes and interprets data to create reports and presents outcomes to
  management. Assist with special project work and project planning for statewide outreach opportunities. Tracks and reports outreach activity for reports required by the Health Care Authority and NCQA.
• Attends and participates in departmental meetings as a means for receiving education and training on new policies procedures and regulations.
• Networks develops and manages collaborative relationships with key contacts from external advocacy agencies; researches and responds to advocate requests regarding complex situations. Supports internal departments with education and support with escalated benefit or service inquiries; internal departments to include but not limited to; Government Programs Administration Sales PCSC Enrollment Claims Experience Design Program Appeals and Grievance Health Services Provider Network Management.
• Plans and conducts service and business recovery initiatives; contacts members to increase participation and educational and special events
• Completes all required training to remain current with state and federal regulations related to government programs PHS/PHP policies and procedures; maintains appropriate State of New Mexico licensure and certifications.
  Develops and maintains relationships with Federally Qualified Health centers Health Care Authority and advocacy agency representatives.
• If/when applicable Develops and maintains external relationships with key representatives of IHS facilities Urban Indian Health clinics tribally operated facilities.
• Acts as Agent of the State in order to help facilitate the Medicaid application process on behalf of the State of New Mexico and Presbyterian.
• Works independently and ability to make independent decisions to ensure required Health Care Authority contract requirements are met.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision short-term and long-term disability group term life insurance and other optional voluntary benefits.

Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges webinar preventive screening and more.

Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned not-for-profit healthcare system of nine hospitals a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees - including more than 1600 providers and nearly 4700 nurses.

Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.