AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!
Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you!
Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.
STILL INTERESTED? Please continue!
AIDS Healthcare Foundation is currently hiring for the following position: Licensed Program Representative for our Managed Care business line. This is a regular full time position, based in our Ft. Lauderdale, Florida offices located at 110 SE 6th Street, Suite 1960. Please see bottom of posting for further information
Summary:
The Licensed Program Representative works with the Enrollment, Sales and Member Services Departments to enroll members into AHF MCO’s managed care programs and to provide customer service to members of those health plans. Works collaboratively with all other departments of the Managed Care Division, including those located in California. Works collaboratively with AHF MCO’s subcontracted entities providing customer service, such as Connextions, to ensure a seamless delivery of services to prospective and current enrollees.
Essential Duties & Responsibilities
Includes but are not limited to the following:
• Thoroughly describes and explains the Positive Healthcare Partners (PHP) and Positive Healthcare (PHC) benefits and exclusions to prospective enrollees.
• Explains and discloses all member rights, privileges, exclusions, and limitations of AHF MCO’s Managed Care Programs, Positive Healthcare Partners (Medicare Advantage Part D Special Needs Plan) & Positive Healthcare (Medicaid Reform Special Needs HMO).
• Addresses a wide variety of enrollee inquiries or concerns and answers all questions related to these concerns. Directs enrollee grievances or complaints to the appropriate personnel or departments for follow-up.
• Educates enrollees regarding plan benefits, exclusions and operations, including instructions on how to navigate within each health plan’s policies and procedures.
• Participates in scheduling and accommodating group presentations as directed by Enrollment & Sales Mgr.
• Maintains current knowledge of HIPAA confidentiality regulations and ensures that violations do not occur.
• Participates in HIV-related community events and other venues for outreach. Assists Enrollment & Sales Mgr. in ensuring that any applicable federal and state guidelines for AHF MCO’s participation in such community events are adhered to and that any required marketing approvals are obtained from the appropriate agency(ies).
• Represents the organization in a professional and positive manner in the marketplace.
• Maintain current knowledge of Medicare Marketing Guidelines Manual and all CMS updates to those guidelines throughout the contract year. Also maintain current knowledge of Medicare Managed Care Manual, Chapter 2, Enrollment & Disenrollment guidelines.
• Maintain knowledge of PHP and PHC Internal Policies and Procedures.
• Assures all potential Medicaid Reform enrollees are referred to Choice Counseling prior to enrollment in Positive Healthcare, the Medicaid Reform Plan.
• Other duties as assigned.
Participation in AHF Meetings/Committees:
Attendance to staff meetings or Committees as assigned by Manager.
Education and/or Experience:
Three to five years experience in community outreach, managed health care, or related fields are required.
Computer/Software Skills & Abilities:
To perform this job successfully, an individual should have knowledge of Spreadsheet software and Word Processing software.
Other Skills & Abilities/Qualifications:
Must be able to travel 100% of the time.
Strong interpersonal communication skills.
Ability to work with minimal supervision.
Sensitivity to AIDS/HIV related issues and concerns.
Experience in health care benefits (Medicare, Medicaid) preferred.
Bi-lingual (English/Spanish) strongly preferred.
Certificates, Licenses and Registrations:
Valid Florida drivers license with proof of automobile liability insurance.
Maintains all necessary sales/enrollment licensure or accreditations required by Florida Medicaid or Medicare.(e.g., Licensed Florida Insurance Agent).
Supervisory Responsibilities
This position does not include any supervisory responsibilities.
Language Skills
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Additional Information:
Schedule: Monday - Friday
Full-time position
Email resume to: Kathleen.feldman@aidshealth.org or
fax to: 954-522-3260
We look forward to speaking with you soon!
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