Eligibility Counselor I - PR in Guaynabo PR, PR | DiversityInc Careers
 

Eligibility Counselor I - PR

DescriptionThis position services to assist low-income Medicare beneficiaries enrolled in a contracted Managed Care Organization Medicare+Choice health plan, with the qualification and recertification process for Medicare Savings Programs. The recertification team conducts telephonic outreach to remind, assist, and keep the members enrolled by either phone outreach or mailings. This outreach is performed before and around the members’ recertification date.

Responsibilities:
• Conducts telephonic outreach activities for members who need to recertify and are eligible for the Medicare Savings Programs. May also need to contact the state to properly complete the recertification process.
• Completes MSP renewal applications if needed for members. Also, insure that applications are completely filled out and every question is answered correctly before the member submits it to the state.
• Must conduct proper and effective follow up to ensure state renewal applications are sent to the state in a timely manner and Altegra Health documents are received to conduct further assistance.
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, make accurate and descriptive MMS documentation
• Participates as required in Altegra Health's staff and operational development programs. Acts as a team player and communicates openly and honestly.
• Maintains current knowledge of state and federal regulatory requirements to adhere to strict compliance of all aspects Altegra Health's Outreach Operations.
• Demonstrates behaviors, actions, and attitudes that reflect Altegra Health's vision, mission and values.
• Performs other duties as assigned.
RequirementsQualifications:
• High School Education; Associates Degree or Bachelors Degree preferred.
2 years experience with direct consumer interaction, telephone sales experience, and Medicaid program experience preferred.
• Demonstrated application of data entry and related computer skills.
• Excellent oral communication skills; ability to communicate with elderly individuals and state governmental personnel.
• Ability to analyze and interpret governmental program criteria; ability to interact and decipher information via telephonic or correspondence inquires.
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