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Care Advocate

2 months ago

Greenville, South Carolina, United States CHS Full time

About the Role:

The Care Advocate - Support Specialist will play a vital role in supporting members with acute and chronic clinical conditions for the Medically Complex Children's Waiver program in South Carolina.

Key Responsibilities:

  • Maintain the confidentiality of all Personal Health Information (PHI) collected
  • Act as a member advocate, providing support, triage, and referral access to the clinical staff
  • Participate in all client-specific program, process, and quality training programs
  • Document information into Phoenix as directed by the nursing staff
  • Place outreach calls to members/responsible parties for coordination, scheduling, collecting demographic/non-clinical information, referrals, DME requests, and other ancillary provider requests, as directed by nursing staff
  • Assist providers' offices with member-specific missed appointments through member outreach and scheduling
  • Answer incoming calls requesting services
  • Participate in the collection and reporting of information as defined by the monthly reporting requirements
  • Use reason and logic to solve problems during the review process and maintain a positive, professional, and respectful attitude with peers and clients
  • Research and secure new telephone numbers to contact members
  • Review and analyze claims data in accordance with coordination for financial reports
  • Work with clinical staff in the performance of all non-clinical/administrative tasks associated with the MCCW program
  • Assist with translation calls with care coordinators, if bilingual (primarily Spanish)
  • Have access and manage PHI in accordance with federal and state requirements (HIPAA, HITEC)

Additional Responsibilities:

  • Adhere to the policies and procedures of Community Health Solutions
  • Maintain strict confidentiality of client, company, and personnel information
  • Demonstrate a strong commitment to the mission and values of the organization
  • Adhere to company attendance standards
  • Perform other duties as assigned

Requirements:

  • A minimum of two (2) years of work experience in a medical office setting
  • Proficiency in data entry skills
  • Strong customer service/telephone skills
  • Medicaid experience a plus
  • Bilingual (Spanish) preferred

Education and/or Experience:

  • A high school diploma or equivalent is required. Knowledge of medical terminology is required.

Certificates, Licenses, Registrations:

  • Certified Medical Assistant, Certified Community Health Worker

Computer Skills:

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

Environmental Factors/Physical Demands:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input, and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry, and vision to monitor. May be subject to bending, reaching, kneeling, stooping, and lifting up to thirty (30) pounds.