Medicare Services Coordinator - Aging Services

Req # 2021-12769

Work Boldly. Live Brilliantly.

Bold decisions and innovative thinking have helped AltaMed, headquartered in Commerce, Calif., become the nation’s largest network of community-based primary care clinics and senior care programs. Some 2,000 professionals in medicine, nursing, social work, mental health rehabilitation, dentistry and health administration assure that we not only provide quality care, but that we do so without exception or regard to ability to pay. We are JCHAO-accredited, and strongly focused on wellness, preventative care and eliminating health care disparities.

Job Description

The Medicare Services Coordinator for senior members will provide member-centric services to newly enrolled members of senior plans to increase retention and engagement. The Medicare Services Coordinator is the point of contact for an in-depth orientation and services coordination in the first 90 days following enrollment including making welcome calls, explaining and providing coordination of the health plan benefits and services available; providing explanation of plan benefits, identifying service needs such as transportation to and from appointments and ensuring the member more easily accesses needed care with minimal barriers. This position will require coordination of services required by regulation such as Health Risk Assessment/Medicare Health Assessment, identification of problem areas or concerns, appropriate interventions/services to be arranged, any additional plan specific requirements and maintaining a comprehensive and progressive record of all coordination activities including need for escalating problems or issues. Responsibilities include liaising with providers and staff responsible for coordinating follow up and ensuring systematic check-ins with the member during the onboarding process. This position will require providing warm hand-offs with assistance services and identifying opportunities to improve efficiencies and customer service. The Medicare Services Coordinator ensures the best member experience possible from beginning to end.

 

Qualifications

1. High School diploma or equivalent required.
2. 3 years’ experience working in a healthcare customer service/ care coordination environment; knowledge of plan benefits and regulations governing Medi-Cal, Commercial, Medicare and other government and commercial programs. Bachelor’s in social work (or related field) with senior plans and patient-centric experience, or Medical Assistant or LVN desirable.
3. Minimum 3 years of experience in a managed health care environment, preferably IPA, HMO, or Health Plan preferred in addition to experience working with an ethnically diverse population.
4. Bilingual English/Spanish preferred.

Responsibilities

1. Generates/manages the daily new member census for welcome calls and orientation.
2. Coordinates and assists with patient appointments as needed and notifies patient of authorization status.
3. Coordinates for and/or obtains Health Risk Assessment forms from Health Plan partners.
4. Creates and maintains tracking reports for follow up calls on a scheduled basis.
5. Coordinates or escalates as needed complex member/patient inquiries and other issues with applicable internal/external functions.
6. Facilitates communication with providers, clinic staff, external service providers to ensure authorizations and access to care.
7. Responsible for staying current on community resources and attending resource specific training as required.
8. Follows up to verify that needs are being met, services are being delivered.
9. Intervenes at the member level to coordinate the delivery of direct services to members and their families.
10. Serves as the point person during the onboarding process to patients, providers, staff, and external vendors regarding benefits, service requirements and care coordination.
11. Gathers relevant information during onboarding process to facilitate care coordination and handoffs.
12. Performs all other related duties as assigned.

Benefits

AltaMed offers a comprehensive benefits program that recognizes the needs of our diverse employees by supporting their health, security and professional growth.

Wellness

• Medical/Dental/Vision Plans
• Voluntary Short-term Disability Plan
• Long-term Disability Plan
• Paid Time Off
• Health Care and Dependent Care Reimbursement Accounts (FSA)
• Employee Assistance Program (EAP)

Planning Ahead

• 403 (b) Retirement Plan
• Life Insurance (Basic & Voluntary)
• Accidental Death & Dismemberment (Basic & Voluntary)
• Career Growth and Development
• Tuition Reimbursement
• Continuing Education Programs

Other Benefits

• Employee Reward & Recognition Programs
• Corporate Employee Discount Programs
• Wellness Programs

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