Member Advocate (El Paso Health)
: Job Details :

Job SummaryServes as an advocate to assist and/or represent STAR, CHIP, and El Paso Health Advantage Dual SNP members in navigating through their covered services, including preventive services, rights and responsibilities, complaint and appeals processes and providing education and support in accessing available services. Assists the member in accessing non-covered services, such as those provided in other social service or community programs. Skills1. Computer and typing skills required.2. Excellent verbal and written communication skills required.3. Ability to follow written and oral instructions.4. Ability to work reliably and independently.5. Ability to work effectively as a member of a team.6. Ability to seek out new methods and principles to improve service.7. Strong Customer Service skills and orientation.8. Bilingual English/Spanish highly preferred (written and verbal). Work ExperienceThree years of experience in the managed care industry, care coordination, health promotion/outreach, and/or social services experience required. Complaints and appeals resolution experience preferred. Member Advocate experience preferred. Knowledgeable about STAR, CHIP, and Medicaid/Medicare covered services, value-added services, preventive services, Social Security application process, emergency services, service/case management, non-clinical questions about referrals, authorizations, scheduling appointments PCP information and the role of the PCP/MCO, WAF including the Lock-in Program, assisting SHCN Members, Behavioral Health Services, Nursing Facility Services, ANE, DME/Emergency Prescription (72-hour) process, and cost sharing information relating to premiums, co-pays or deductibles, as applicable. License/Registration/CertificationValid State driver's license.General Lines - life, accident, health and HMO license issued through the Texas Department of Insurance preferredEducation and TrainingHigh school diploma or equivalent required. Bachelor degree in Business, Health Science, Marketing or related field preferred.