Member Financial Counselor

Member Financial Counselor

Job Summary

The Member Financial Counselor will directly support ArchWell Health members with signing up for state and federal assistance programs to aid members in optimizing benefits they are eligible to receive, in addition to providing support for member finance inquiries for ArchWell Health and non-ArchWell Health medical bills. This role will require technological proficiency and the ability to competently navigate the requirements of the health plans, state and federal assistance programs. This role will have a significant data input component to ensure success of the program is captured and understood across Centers and Markets. This is a professional role where ongoing feedback will be provided and working closely with the Member Financial Counseling leadership is a requirement.

Duties/Responsibilities:

Connect with members over the phone to assist in completing paperwork for eligibility determination, enrollment, and recertification of state and federal programs; including but not limited to Medicaid, D-SNP, Medicaid and Medicare Savings Program (MSP), Low-Income Subsidy (LIS), Supplemental Nutrition Assistance Program (SNAP), and Low Income Home Energy Assistance Program (LIHEAP)

Provide member support in a contact center environment, meeting established productivity, quality, service, and compliance standards while delivering effective solutions that achieve desired member outcomes, support financial well-being, and enhance the overall member experience.

Intake/initiate inbound and outbound calls with members to provider education, resolve benefit-related concerns, and identify opportunities for enhanced coverage

Proactively identify members who are eligible for the programs available to reduce member financial responsibility

Receiving inbound calls from members during established coverage windows

Evaluate, research and document financial histories of patients in relation to Medicaid and other state/federal program regulations.

Enter/update data into various internal and external systems (financial management system, Medical Eligibility Program database, etc.). Inputs necessary data to assist in the necessary capture for reporting.

Contact physicians, nurses, social workers, employers, banks, etc. to obtain appropriate medical, legal and financial information to complete Medicaid.

Support ArchWell Health Cost Share Assistance Program

Exercise and maintain patient confidentiality by complying with all federal, state, and local statues or other agency regulations pertaining to confidentiality and patient’s right to privacy.

Other related duties as directed by financial program leader.

Required Skills/Abilities:

Strong working knowledge of Medicaid, SNP and assistance programs, financial counseling practices, eligibility requirements and procedures for multi-state and federal programs

Strong understanding of state and federal assistance programs, including Medicaid, and managed care plan enrollment and participation requirements, with multi-state Medicaid experience preferred

Excellent verbal communication and active listening skills, with the ability to conduct effective member conversations, assess needs, provide education and guidance, and influence positive member outcomes

Ability to partner and communicate with stakeholders in a professional manner

Strong organization and written communication skills

Excellent problem-solving skills

Proven performance results, decision making and judgement

Strong PC skills with ability to navigate state benefit portals and eligibility systems.

Must understand medical insurance to be able to discuss and explain balances, deductibles, co-pays, co-insurance. Ability to read and interpret an explanation of benefits (EOB).

Ability to understand and present data

Ability to communicate well with all levels of staff, providers, patient referral sources, and members

Occasional travel required (5-10%)

Minimum Qualifications

Bachelor’s degree preferred, or equivalent experience; H.S. diploma or equivalent required

Minimum of 3 years experience related to Medicaid and other assistance program eligibility required

Advanced working knowledge of Medicaid, Medicare Advantage, and other state and federal benefits programs serving seniors, including eligibility requirements, enrollment processes, benefit coordination, and plan selection.

Ability to independently guide members through benefits counseling and enrollment activities.

Experience with multi-site healthcare delivery organizations desired

Experience with capitated risk-based reimbursement models strongly preferred

Proficient in Microsoft Word, Excel, PowerPoint, Outlook

Ability to learn and work with different software to perform duties of role, including Salesforce, Teams, and eCW (eClinical Works)

Embodies and serves as a role model of ArchWell Health’s Values:

Be compassionate

Strive for excellence

Earn trust

Show respect

Stay resilient

Always do the right thing

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Where you can work from

This job is 100% remote, for applicants who live in the United States.