SCOPE OF POSITION:
Responsible for assisting individuals as they look for health coverage options through the marketplace. Educate individuals about the Marketplace and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Maintain comprehensive knowledge of the Arkansas Medicaid and PASSE programs in order to establish communication, education and monitoring to assisting clients. Provide communication, education and promotion of program services as required. Collaborate with medical and other professional staff to meet contract deliverables ensuring timely provision of services and appropriate follow up. Document services rendered and provide reporting as required.
ESSENTIAL JOB FUNCTIONS:
- Maintain expertise in eligibility, enrollment and program specifications for qualified health plans (QHPs) and insurance affordability programs, and \conduct public education activities to raise awareness about the Marketplace.
- Must inform consumer about the full range of QHP options and insurance affordability programs for which they may be eligible, which includes: providing consumer with fair, accurate, and impartial information that assists them with submitting a Marketplace eligibility application; clarifying the distinctions among health coverage options, including QHPs; and helping them make informed decisions during the health coverage selection process.
- Coordinate communication between various components of the AR Medicaid program.
- Maintain comprehensive knowledge of specialty area, pertinent organizations and health care environment. Knowledge should include information regarding: contract, contract deliverables, policies and procedures, resources available, current research and reports, trends, etc
- Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
- Communicate effectively with customers and/or recipients. Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
- Act as a resource to internal and external customers for information pertaining to specialty area focus.
- Understand and utilize project-tracking database to document and monitor services/activities provided and to compile a comprehensive database of activity. Maintain accurate statistical data to meet contractual and other reporting requirements.
- Coordinate the timely collection and data entry of all required documentation.
- Work with Information Technology department to coordinate system developments and customizations.
- Assist in the creation and maintenance of necessary reports/documents to track and report project information. Prepare ad hoc reports and/or statistics as directed.
- Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement and follow through for compliance of recommendations for improvement.
- Assist in the development, production, maintenance and delivery of educational materials/activities.
- Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
- Communicate needs and requests to other team members as appropriate.
- Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
- Additional duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS (WITH OR WITHOUT THE AID OF MECHANICAL DEVICES):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.
Required Skills
KNOWLEDGE, SKILLS AND ABILITIES:
- Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
- Type 50 wpm
- Exceptional skills in business English and spelling
- Ability to maintain confidentiality
- Strong oral and written communication skills
- Creativity
- Customer service
- Ability to meet deadlines
- Attention to detail
- Flexibility
- Ability to work collaboratively and independently to achieve stated goals
- Initiative
- Ability to relate professionally and positively with staff, business partners, customers, constituents, beneficiaries and the public
- Ability to multitask
- Ability to prioritize
- Strong organizational skills
- Problem solving skills
- Professionalism
- Project management skills
- Ability to read, interpret and apply laws, rules and regulations
- Knowledge of quality improvement processes and techniques
- Time management skills
- Ability to work overtime as needed
Required Experience
EDUCATION:
Required: High School Diploma
EXPERIENCE:
Required: Bilingual English/Spanish. Two (2) years’ experience within the healthcare arena, customer relations, and thorough understanding of the Medicaid Guidelines
Equal Opportunity Employer/Veterans/Disabled EEO IS THE LAW
AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law. AFMC invites any employee and/or applicant to review the Company’s Affirmative Action Plan. This plan is available for inspection upon request, which may be made in person or by telephone (501) 212-8798, by fax (501) 212-8797 or by U.S. mail Attn: Michael Dumas, 1020 West 4th Street, Suite 300, Little Rock, AR 72201.