Description:
The Account Specialist is responsible for identifying prospective members who do not have health insurance, determine the appropriate plan for the individual or family and enroll them into one of the health programs offered by Healthfirst such as Medicaid, Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plan (QHP), Medicare or Complete Care. Customarily and regularly works away from Healthfirst’s place of business. The Account Specialist will collaborate closely with the Delivery Services Engagement team that works with providers, to identify provider related issues, address and resolve these issues as well promote Healthfirst to ensure visibility and increase market share. The Account Specialist will recertify members into Medicaid, CHP, EP, and QHP. This position will market exclusively in Westchester County
Duties and Responsibilities:
- Identifies potential members and designs a plan to educate potential members regarding the health benefits and care that is tailored for the member as well as provide information regarding the particular plan’s features and benefits.
- For existing members, will review current benefits to determine appropriate plan, assist with recertifying their existing coverage or suggest transfer to alternative plan that is better aligned for their care. Will provide guidance and assistance to recertify the member’s healthcare coverage for Medicaid, CHP, EP and QHP, Medicare or Complete Care as well as adding on additional eligible family members
- Assist members with selecting high-quality Primary Care Physician (PCP), order member ID card and make monthly premium payment. This includes using the Healthfirst provider directory via the provider search tool, verifying the correct information in Salesforce/Member 360/OnContact/BizTalk before making any necessary changes based on member’s request.
- Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually
- Educate members about digital tools including HF mobile application, Twilio, as well as NowPow
- Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures.
- Identify and develop business opportunities within assigned territories
- Conduct monthly group presentations targeting small businesses and providers
- Conduct monthly field outreach targeting pharmacies and supermarkets
- Partner with Community Engagement to organize events within the sales territory, including but not limited to health fairs, parades, holiday-themed events, trade show expos, hospital orientations, provider sponsored events as well as health related theme events.
- Establish and maintain relationships with local community organizations to promote HF benefits in the community
- Assist DSE for follow up visits with providers to ensure plan visibility and create leads generation
- Provide DSE feedback and follow up for provider related issues and solutions
- Assist DSE to conduct Provider portal orientation for new providers; educate the practice on how to navigate the provider portal (member eligibility, authorization, claim look up, membership roster, quality reports) to solidify the business relationship with providers and to support quality score improvement
- Provide leads to DSE on new provider recruitment to diversify our network (FQHC, Dental, Pharmacy, Hospital, IPA, community providers)
- Advance Healthfirst through superior customer service focused in an assigned territory, which will help optimize provider and member satisfaction
- Raise any issues/ concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.
Minimum Qualifications:
- A Valid Driver’s License
- New York State Life Accident (optional) & Health License (Mandatory)
- Associate degree with experience in one of the following: sales, marketing, provider relations
- 3 years of sales experience (1 year in health insurance industry)
- Knowledgeable and experience working with provider network/hospital
- Bilingual-English and one or more of the following: Yoruba, Twi, French, Wolos, Arabic, Spanish
- Excellent communication & interpersonal skills (Oral & Written)
- Good computer skills & tech savvy (Microsoft Office)