Medicaid Outreach and Retention Representative

Presbyterian is seeking a talented Medicaid Outreach and Retention Representative.

The Medicaid Outreach and Retention Rep is responsible for statewide education, outreach, acquisition and retention of Presbyterian Medicaid members and acquisition of prospects. Represents Presbyterian in the community; networks, develops, and manages relationships with key government and community advocate agencies. Creates and conducts educational presentations for internal and external customers; response to escalated inquiries requiring research and resolution of complex issues. Applies CMS, NCQA, and State of New Mexico regulations and established PHP approved policies, procedures, and guidelines in all customer contacts, member initiatives and communication materials. Responsible for submission process of time-sensitive contracts from external entities to Legal Services. Requires excellent communication, analytic, organization, and time management skills.

• This is a Full Time position - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days

• Bachelors degree preferred; Associates degree or 3 years experience in lieu of degree.
• Demonstrated abilities through education and/or work experience. Bilingual Spanish-speaking, reading and writing preferred.
• Speak and understand one or more of New Mexico Native American languages (Tribes, Nations, or Pueblos), if applicable
• Obtain New Mexico State Presumptive Eligibility/ Medicaid On-site Application Assistance [PE/MOSAA] certification required or obtained within 90 days of hire. 2-3 years experience in managed care organization preferably in Medicaid Plans and other dual-eligible or long-term care market products and programs.
• And/or 3-5 years customer service experience in health insurance, healthcare retention, community outreach or marketing.
• Additionally, healthcare claims processing, provider network, or other background in research and resolution of complex issues experience preferred.
• Excellent public speaking and presentation skills; demonstrated ability to communicate effectively in person, by phone and in writing to people with different cultural and socio-economic backgrounds.
• Excellent PC skills; MS Office/Windows required; database experience preferred; experience with integrated data management systems. Ability to travel within the State of New Mexico based on assigned territory and departmental need.
• Must be able to lift 35 to 70 pounds, packing, loading, event set up and take down regularly; frequent travel and occasional overnight stays. Must have own vehicle, a valid NM drivers license and maintain a good driving record.
• Must provide own transportation and be able to travel.
  If/when applicable - Working knowledge of Medicare Advantage program. Other duties as assigned

• Organizes, facilitates, and participates in community outreach and customer education events effectively communicating program attributes, plan benefits, services available, product changes, and regulatory requirements to a variety of audiences resulting in prospects successful application to the appropriate program.
• Secures supplies and marketing materials used in outreach and enrollment activities. Projects positive organizational image to the public. Prepares education materials to include handouts, workbooks, evaluation forms, and visual aids; reviews materials for compliance and quality.
• Educates members on a variety of governmental and commercial products; assists prospects and members with enrollment in Medicaid. Must be able to understand both business and member views in order to communicate necessary information so that it meets both business needs and member experience requirements.
• Researches, compiles, analyzes and interprets data to create reports and presents outcomes to
  management. Assist with special project work and project planning for statewide outreach opportunities. Tracks and reports outreach activity for reports required by the Health Care Authority, and NCQA.
• Attends and participates in departmental meetings as a means for receiving education and training on new policies, procedures and regulations.
• Networks, develops, and manages collaborative relationships with key contacts from external advocacy agencies; researches and responds to advocate requests regarding complex situations. Supports internal departments with education, and support with escalated benefit or service inquiries; internal departments to include, but not limited to; Government Programs Administration, Sales, PCSC, Enrollment, Claims, Experience Design Program, Appeals and Grievance, Health Services, Provider Network Management.
• Plans and conducts service and business recovery initiatives; contacts members to increase participation and educational and special events
• Completes all required training to remain current with state and federal regulations related to government programs PHS/PHP policies and procedures; maintains appropriate State of New Mexico licensure and certifications.
  Develops and maintains relationships with Federally Qualified Health centers, Health Care Authority, and advocacy agency representatives.
• If/when applicable Develops and maintains external relationships with key representatives of IHS facilities, Urban Indian Health clinics, tribally operated facilities.
• Acts as Agent of the State in order to help facilitate the Medicaid application process on behalf of the State of New Mexico and Presbyterian.
• Works independently and ability to make independent decisions to ensure required Health Care Authority contract requirements are met.

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

 

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities—like challenges, webinars, and screenings—with opportunities to earn gift cards and other incentives.

 

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

 

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $33.14/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.