Service Coordination Advocate
Harris Health
- Houston, TX
- Permanent
- Full-time
- Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
- Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
- Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
- Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
The Service Coordination Advocate at Community Health Choice is detail-oriented and proactive having a vital role in supporting the coordination of healthcare services for our STAR+PLUS members. This position provides administrative support to the Service Coordinator in managing service requests, scheduling, and rescheduling appointments, completing Health Risk Assessments, and ensuring the smooth operation of service delivery.The Service Coordination Advocate collaborates with various internal departments, healthcare providers, and external stakeholders to ensure seamless service delivery and member satisfaction.JOB SPECIFICATIONS AND CORE COMPETENCIESInbound Call Support:
- Respond effectively and timely to inbound calls from STAR+PLUS members and providers regarding scheduling and rescheduling assessments, answering benefits and eligibility questions, claims processing status, and authorization status.
- Conduct motivational interviewing when gathering supporting information from members or Legally Authorized Representatives (LAR) to ensure smooth operation of service delivery.
- Maintain a working knowledge of the STAR+PLUS program, care management system (OICS), claim systems, and accurately enter required information into the designated Customer Relationship Management system (CRM) and the OICS system, adhering to departmental and organizational policies and procedures.
- Work collaboratively with coworkers and internal departments (Medical Affairs, Member Services, Provider Services, Claims, and other internal groups) to deliver member/provider services that meet or exceed expectations.
- Other duties as assigned.
- Education/Specialized Training/Licensure: High school diploma or equivalent required
- Experience with the STAR+PLUS population, waivers, IDD programs, and Community First Choice (CFC) preferred.
- Work Experience (Years and Area): Three (3) years of health care/plan experience, including call center experience and knowledge of pharmacy benefits, claims, and authorization status.
- Proven experience in administrative roles, preferably in the healthcare or insurance industry.
- Experience with call center phone applications (i.e., Avaya, NICE, Witness, Finesse, etc.).
- Software Proficiencies: Call Center Phone applications (i.e. Avaya, NICE, Witness, Finesse etc.)