Care Advocate - Columbia, SC

Overview

The Care Advocate position, located in Columbia, SC, is a telephonic, work-from-home position with occasional travel required.

Mileage is reimbursed. 

Position Summary:The Care Advocate is a non-clinical position that assists the clinical staff in supporting members with acute and chronic clinical conditions for the Medically Complex Children’s Waiver program in South Carolina.

Responsibilities

Essential Duties and Responsibilities: 

• Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected
• Serves as a member advocate, providing support, triage and referral access to the clinical staff
• Participates in all client specific program, process and quality training programs
• Documents information into Phoenix as directed by the nursing staff. Utilizes Phoenix (SCDHHS controlled software) and provides documentation in Phoenix (SCDHHS controlled software) as directed
• Places outreach calls to members/responsible parties for coordination, scheduling, collecting demographic/non-clinical information, referrals, DME requests, and other ancillary provider requests, as directed by nursing staff
• Answers incoming calls requesting services
• Uses reason and logic to solve problems during the review process and maintains a positive, professional and respectful attitude with peers and clients
• Reviews and analyzes claims data in accordance with coordination for financial reports
• Attends home visits as needed to support the nurses.
• Coordinates Team Conference dates for nurses with local physician offices.
• Verifies Medicaid eligibility on participants and assists participants to maintain eligibility.
• Verifies participant demographics and enters them into the Phoenix system.
• Work with participants and DHHS to obtain the state Medicaid plan services; CPDN, CPCA, IS.
• Assist participants with referrals to outside services such as babynet and transportation services.
• Assist Care Coordinators to obtain paperwork from providers such as physician orders and nursing notes.
• Report insurance changes to the Medicaid system.
• Assist the Team Leads complete report documents for staff productivity.
• Organize agendas for staff meetings under program manager supervision and coordinate lunches for those meetings.
• Sending out sympathy cards for deceased members to families.
• Provider marketing assistance for the program as directed by program manager.  

 Other Responsibilities:

• Adheres to the policies and procedures of Community Health Solutions
• Maintains strict confidentiality of client, company and personnel information
• Demonstrates a strong commitment to the mission and values of the organization
• Adheres to company attendance standards
• Performs other duties as assigned 

Supervisory Responsibilities: None

Qualifications

Qualifications:

• A minimum of two (2) years of work experience as a Certified Nurse Assistant, Medical Assistant or Medical Administrative assistant preferred.
• Proficiency in data entry skills
• Strong customer service/telephone skills
• Bilingual (Spanish) preferred
• Ability to travel locally with a valid drivers' license and automobile insurance 

Education and/or Experience:

• A high school diploma or equivalent is required.
• Knowledge of medical terminology is required. 

Computer Skills:

• Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook 

Environmental Factors/Physical Demands:

While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.