Assesses eligibility and initiates the referral process for VNSNY CHOICE, by entering the referrals in the Pre-Enrollment Browser (PEB), to achieve desired enrollment goals.
Assesses eligibility of potential enrollees; collaborates with New York Medicaid Choice (NYMC) in scheduling Conflict-Free Evaluation and Enrollment Center (CFEEC) assessments, as needed.
Promotes satisfactory enrollee relationships and responds to inquiries about eligibility and requests for program information. Follows up with clients about CFEEC assessment status and collaborates with clients to resolve pre-enrollment problems.
Calls potential enrollees who are referred via fax; reviews their eligibility and transfers them to NYMC, if appropriate.
Compiles data/information, enters into systems/databases or other programs (e.g. referrals) using appropriate software/systems. Maintains accurate data in all applicable systems to ensure timely withdrawals/cancellations, enrollments and accurate claims adjudication.
Documents and tracks calls in appropriate systems. Addresses issues and/or forwards them to appropriate area for resolution.
Works collaboratively with other VNSNY programs as needed.
Confirms attestation date in UAS for enrolled Members.
Conducts pre-enrollment welcome calls to newly enrolled members advising them of their assigned LHCSA and potential HHA hours.
Participates in special projects and performs other related duties as assigned.
Education: Associate’s Degree in health, human services, other related discipline or the equivalent work experience required.
Experience: Minimum two years experience in customer service required. Proficient interpersonal, organizational, strong attention to detail, analytical and writing skills required. Knowledge of Medicaid eligibility requirements required. Proficiency with personal computers, including MS Excel, Word and Outlook required. Prior experience in Call Center setting preferred.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.