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Care Advocate

2 months ago

Greenville, South Carolina, United States CHS Full time

About the Role:

The Care Advocate is a vital member of our team at CHS, responsible for providing exceptional support to our members and clinical staff. This non-clinical position plays a crucial role in ensuring the smooth operation of our Medically Complex Children's Waiver program in South Carolina.

Key Responsibilities:

  • Confidentiality and Data Protection: Maintain the confidentiality of all Personal Health Information (PHI) collected and ensure its secure storage and transmission.
  • Member Advocacy: Serve as a dedicated advocate for our members, providing support, triage, and referral access to our clinical staff.
  • Training and Development: Participate in all client-specific program, process, and quality training programs to enhance knowledge and skills.
  • Documentation and Reporting: Accurately document information into Phoenix, our controlled software, as directed by the nursing staff, and contribute to the collection and reporting of information as defined by our monthly reporting requirements.
  • Outreach and Coordination: Place outreach calls to members and responsible parties for coordination, scheduling, collecting demographic and non-clinical information, referrals, DME requests, and other ancillary provider requests, as directed by the nursing staff.
  • Scheduling and Follow-up: Assist providers' offices with member-specific missed appointments through member outreach and scheduling, as well as assisting care coordinators with scheduling all visits.
  • Customer Service: Answer incoming calls requesting services and provide exceptional customer service to our members and stakeholders.
  • Problem-Solving and Analytical Skills: Utilize reason and logic to solve problems during the review process and maintain a positive, professional, and respectful attitude with peers and clients.
  • Research and Data Analysis: Research and secure new telephone numbers to contact members and review and analyze claims data in accordance with coordination for financial reports.
  • Collaboration and Teamwork: Work closely with clinical staff in the performance of all non-clinical/administrative tasks associated with the MCCW program.
  • Bilingual Support: If bilingual (primarily Spanish), assist with translation calls with care coordinators.
  • Compliance and Confidentiality: Adhere to federal and state requirements (HIPAA, HITEC) and maintain strict confidentiality of client, company, and personnel information.

Additional Responsibilities:

  • Adherence to Policies and Procedures: Adhere to the policies and procedures of CHS.
  • Confidentiality and Integrity: Maintain strict confidentiality of client, company, and personnel information.
  • Commitment to Mission and Values: Demonstrate a strong commitment to the mission and values of CHS.
  • Attendance and Punctuality: Adhere to company attendance standards.
  • Additional Duties: Perform other duties as assigned by management.

Requirements and Qualifications:

  • Work Experience: A minimum of two (2) years of work experience in a medical office setting.
  • Data Entry and Customer Service Skills: Proficiency in data entry skills and strong customer service/telephone skills.
  • Medicaid Experience: Medicaid experience a plus.
  • Bilingual Skills: Bilingual (Spanish) preferred.

Education and Certifications:

  • High School Diploma or Equivalent: A high school diploma or equivalent is required. Knowledge of medical terminology is required.
  • Certifications: Certified Medical Assistant, Certified Community Health Worker.

Computer Skills:

  • Software Proficiency: Proficiency using software programs such as MS Word, Adobe, Gmail, Excel, and Outlook.