Personal Care Specialist

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.

Summary/Position Objectives:
Responsible for conducting outreach, education, health risk assessment and welcome calls to dual eligible a designated group of members. Personal Care Specialists are responsible for membership retention as well. Assists sales staff with outbound calls to dual eligible members not enrolled in the Plan’s Medicare program. Responds to incoming calls from dual eligible members enrolled in the Plan’s Medicare program and answers questions, resolves issues and further educates members on covered benefits and how to obtain services. Provides back up coverage to the enrollment services team with data entry, integrity and membership maintenance.

Responsibilities:
Essential Functions:
Provides information to and coordinates with the Customer Education and Outreach Coordinator to facilitate the development of appropriate outreach and education activities for dual eligible members.
Assists the sales staff by conducting outgoing calls to current dual eligible members, promoting the benefits of enrolling in the Plan’s Medicare Advantage program and scheduling appointments to assist members with completion of Medicare Advantage applications for the Health Plan.
Identifies and schedules appointments to complete enrollment form and explain Mercy Care Advantage benefits.
Responds to incoming calls from dual eligible members enrolled in the Plan’s Medicare program and answers questions, resolves issues and further educates members on covered benefits and how to obtain services.
Conducts welcome calls to members newly enrolled in the Plan’s Medicare Advantage program as well as completes a health risk screening assessment. Calls are completed within 90 days after the enrollment information is transmitted to CMS.
Assist members with questions concerning eligibility, claims, referrals, general coverage questions and any questions concerning their health coverage with the Plan’s Medicare Advantage program. Information provided must comply with the Evidence of Coverage, Summary of Benefits and other Medicare and Plan guidelines.
Documents member grievances and ensures full compliance with related Medicare and Medicaid.
Documents calls received and regularly review call tracking reports to identify trends so that quality improvement initiatives can be identified, developed and implemented.
Upon request, mails Medicare disenrollment forms to members. Documents in call tracking and performs follow-up to ensure timely receipt of disenrollment form.
Meet or exceed established enrollment and member retention goals
Performs other duties, assignments, and responsibilities as assigned or required.

Secondary Functions:
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs.
REQUIREMENTS
Knowledge and Skills:
Complex choice of action – requires considerable logic, understanding to analyze problem and determine course of action.
Excellent oral and written communication skills
Basic data entry skills
Ability to work with minimal supervision
Effectively handles multiple projects simultaneously
Requires work of unusual difficulty in the design, implementation and evaluation of systems or programs
Ability to prepare analytical reports with recommendations
Reads, writes and orally communicates at a level to correctly solicit/explain information to members with lower literacy skills.
Excellent verbal and writing skills; ability to write well and succinctly at all reading levels
Ability to design and develop health education/outreach materials
Must be able to use personal computer and other office equipment

Education and Work Experience:
Bachelor degree in health administration or social work is preferred, although an equivalent combination of formal education and experience may substitute for a degree.
Minimum of three (3) years of Customer Service experience in a healthcare environment, preferably with Medicare and Medicaid experience.
Must possess excellent telephone and problem identification and resolution skills.
Experience working with senior population helpful

Work Environment Qualifications:
Normal Office Environment
Must possess a valid Arizona drivers license
Must possess valid automobile insurance
Ability to be mobile

BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement