Medical, Clinical & VeterinaryClinical Support & Patient Administration
About the job
Requirements
A high school diploma is required; an associate degree is preferred.
At least two years of healthcare work experience, preferably in MLTC, MAP, or PACE programs and/or home care, primarily in intake or enrollment functions.
Knowledge of Medicaid, Medicare, and PACE regulations for eligibility and enrollment.
Proficiency with customer relationship management (CRM) platforms; knowledge of Care Compass is strongly preferred.
Knowledge of Maximus, eMedNY, ePACES, CMS MARx, and related HRA/CMS resources and functions is preferred.
Proficiency in Microsoft Excel, Word, Outlook, Teams, and Microsoft Office products.
Interpersonal skills and the ability to handle situations requiring immediate and urgent attention while meeting targets, projections, and daily task requirements.
Ability to work independently without significant supervisor oversight or direction, and flexibility to meet submission deadlines.
Comprehensive understanding of federal and state healthcare regulatory requirements relating to eligibility, coverage, and services of public programs is a plus.
Familiarity with healthcare organizations and population dynamics in the greater New York metropolitan region is a plus.
Written and oral communication skills; familiarity with medical technology is preferred.
Written and verbal fluency in a secondary language is strongly preferred.
Knowledge of PACE program benefits and services is preferred.
Knowledge of community-based long-term care services for dual-eligible and frail adult populations.
Ability to meet the listed physical and cognitive requirements, including standing, sitting, lifting or pushing/pulling up to 50 pounds, bending or squatting, using stairs and walking, fine motor skills, reading and documenting information accurately, listening and speaking clearly, and sound decision-making and analysis.
Availability to work weekdays, nights, and weekends as applicable.
Responsibilities
Educate prospective participants about the plan and screen them for qualification throughout the onboarding process leading to enrollment in CenterLight's PACE program.
Handle incoming and outgoing calls, data entry, and emails; schedule assessments and mail information to prospective participants.
Meet departmental productivity goals for company growth.
Develop expertise in CenterLight PACE program eligibility requirements, services, and benefits.
Address eligibility issues and process applications; refer cases to Maximus to resolve potential participant issues.
Work with departments across the organization to onboard and retain participants.
Obtain referral details and determine appropriate next steps to expedite enrollment processing.
Evaluate referral-specific factors, including clinical condition, financial situation, entitlement status, and home support systems.
Use screening information to determine which government agencies and team members, including entitlement specialists and assessment nurses, should support the prospect or caregiver in the next enrollment step.
Verify plan and entitlement status using LDSS/HRA/CMS resources and functions.
Verify provider network participation and perform other provider validations.
Enter calls and inquiries in the central database for tracking and follow-up, and schedule appointments with prospects or caregivers.
Monitor and report intake team performance measures to improve onboarding procedures, including CDPAS enrollment, acquisition of entitlements, logistical delivery of service plans, and provider network recruitment requests.
Maintain and generate reports measuring performance and work quality.
Participate in implementing workflows and standard operating procedures.
Advise on the development of tools and process improvements to improve quality and departmental operational efficiency.
Collect and review required documents for enrollment transactions and reconcile enrollment files.
Provide training and process orientations to Business Development team members and other business functions as needed.
Maintain knowledge of applicable CMS, DOH, and PACE guidelines, including organizational and departmental policies and procedures.
Maintain compliance with Medicaid, Medicare, and PACE regulations.
Perform other duties as assigned or requested.
Desired Qualifications
Knowledge of Care Compass.
Knowledge of Maximus, eMedNY, ePACES, CMS MARx, and related HRA/CMS resources and functions.
Comprehensive understanding of federal and state regulatory requirements relating to healthcare eligibility, coverage, and public-program services.
Familiarity with healthcare organizations and population dynamics in the greater New York metropolitan region.
Familiarity with medical technology.
Written and verbal fluency in a secondary language.
Knowledge of PACE program benefits and services.
JOB PURPOSE: The Intake Navigator will directly educate a prospective participant through the onboarding process leading to enrollment in CenterLight’s Program of All-inclusive Care for the Elderly (PACE). This person will work closely with referral sources, account managers, clinical intake and provider relations to ensure all and tasks are efficiently completed associated with the enrollment process. The Intake Navigator is expected to maintain ethical conduct, compliance with state, federal and PACE regulatory requirements, and will be responsible for quality and satisfaction of prospective participants, caregivers and referral sources.
JOB RESPONSIBILITIES: Correspond directly with the prospective participants to provide plan education and qualification screening. Respond to all incoming/outgoing calls, data entry, emails. schedule assessments and mail information to prospective participant. Meet the departmental productivity goals as specified by management for the growth of the company. Become an expert about CenterLight PACE program eligibility requirements, services and benefits. Address eligibility issues, application processing and referrals to Maximus to resolve potential participant issues. Work closely with all departments to onboard and retain participants. Obtain referral details to assess and determine appropriate next steps for expeditious enrollment processing. Evaluate factors unique to each referral including, but not limited to their clinical condition, financial situation, their entitlements status and home support systems. Use knowledge obtained through the qualification screening to determine which government agencies and team members (entitlements specialists, assessment nurses, etc.) should be assigned to the prospect or caregiver in the next step of enrollment. Verify plan and entitlement status utilizing LDSS/HRA/CMS resources and functions. Perform provider network verification and other validation of provider participation. Enter calls/inquiries into central database for tracking and follow-up and schedule appointments with the prospect/caregiver. Monitor and report Intake team performance measures to improve delivery and execution of onboarding procedures (CDPAS enrollment, acquisition of entitlements, logistical delivery of service plans, request for provider network recruitment, etc.). Maintain and generate reports to measure performance and quality of work as set forth by CenterLight. Participate in implementing workflows and Standard Operating Procedures. Advise on the development of tools and process improvements to increase quality and departmental operational efficiencies. Collect and review completeness of all required documents for processing enrollment transactions and reconciliation of enrollment files. Provide training and process orientations to Business Development team members and other business functions as needed Maintain knowledge of all applicable CMS, DOH, and PACE-specific guidelines, including organizational and departmental policies and procedures. Maintain compliance with Medicaid, Medicare, and PACE regulations. All other duties as assigned or requested.
Weekly Hours: 40 Schedule: 8:30AM – 5:30 PM
QUALIFICATIONS:
Education: High School Diploma required, Associate Degree preferred.
Experience: Minimum 2 years work experience in healthcare; preferably with MLTC, MAP, or PACE programs and/or homecare; primarily in intake/enrollment functions. Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment. Proficiency with CRM platforms; knowledge of Care Compass strongly preferred. Knowledge of Maximus, eMedNY, ePACES, CMS MARx and other related HRA/CMS resources and functions, preferred. Proficiency in Microsoft Excel, Word. Outlook and Teams. Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while meeting targets and projections and performing daily tasks. Highly organized and flexible to meet submission deadlines. Experience in working independently without significant oversight and or direction from a supervisor. Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage and services of various public programs a plus. Familiarity with healthcare organizations and general population dynamics within the greater New York Metropolitan region a plus.
Other: Excellent written and oral communication skills a must, familiar with medical technology preferred. Written and verbal fluency in a secondary language strongly preferred. Proficiency in Microsoft office products. Knowledge of PACE program benefits and services preferred Positive attitude and outlook with the ability to multi-task in a constantly changing environment Knowledge of community-based long-term care services to dual eligible and frail adult population. Highly organized and flexible to meet submission deadlines. Experience in working independently without significant oversight and or direction from a supervisor. Weekdays, nights and weekends may apply.
Physical Requirements Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: Standing – Duration of up to 6 hours a day. Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.) Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual. Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer:Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
Salary Range (Min-Max):
$66,300.00 - $71,000.00
Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-related qualifications and applicable employment laws.