What are the responsibilities and job description for the Member Advocate I (168760) position at Professional Management Enterprises?
Summary:
Act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote Member education, identify and resolve any systemic barriers that limit Members access to appropriate care.This is a hybrid role. Four weeks of in-office training required, then would transition to being on rotation for working in office (one week, every five weeks).
Job Title: Member Advocate I
Location: 429 N. Pennsylvania St, Ste 109, Indianapolis, IN 46204
Hours: 8am - 5pm Mon-Fri
**Weekly Pay**
Job Responsibilities:
* Receive and respond to Member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure.
* Investigate and resolve access and cultural sensitivity issues identified by Member Services staff, State staff, providers, advocacy organizations and recipients.
* Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and update and revise educational materials as appropriate.
* Serve as primary contact for Member advocacy groups, human services agencies and the State entities.
* Maintain confidentiality per HIPAA guidelines.
Education/Experience:
High school diploma or equivalent. 3 years of customer service experience in a healthcare environment. Medicare and/or Medicaid experience preferred.
Bilingual in Spanish preferred
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote Member education, identify and resolve any systemic barriers that limit Members access to appropriate care.This is a hybrid role. Four weeks of in-office training required, then would transition to being on rotation for working in office (one week, every five weeks).
Job Title: Member Advocate I
Location: 429 N. Pennsylvania St, Ste 109, Indianapolis, IN 46204
Hours: 8am - 5pm Mon-Fri
**Weekly Pay**
Job Responsibilities:
* Receive and respond to Member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure.
* Investigate and resolve access and cultural sensitivity issues identified by Member Services staff, State staff, providers, advocacy organizations and recipients.
* Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and update and revise educational materials as appropriate.
* Serve as primary contact for Member advocacy groups, human services agencies and the State entities.
* Maintain confidentiality per HIPAA guidelines.
Education/Experience:
High school diploma or equivalent. 3 years of customer service experience in a healthcare environment. Medicare and/or Medicaid experience preferred.
Bilingual in Spanish preferred
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.