Care Advocate

Overview:

Applicants must live in the State of South Carolina.

This is a work-from-home position within a designated South Carolina territory community.

The Care Advocate is a non-clinical position that assists the clinical staff in supporting members with acute and chronic clinical conditions for the Medically Complex Children’s Waiver program in South Carolina.

Responsibilities:

• Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected
• Serves as a member advocate, providing support, triage and referral access to the clinical staff
• Participates in all client specific program, process and quality training programs
• Documents information into Phoenix as directed by the nursing staff. Utilizes Phoenix (SCDHHS controlled software) and provides documentation in Phoenix (SCDHHS controlled software) as directed
• Places outreach calls to members/responsible parties for coordination, scheduling, collecting demographic/non-clinical information, referrals, DME requests, and other ancillary provider requests, as directed by nursing staff
• Assists providers’ offices with member specific missed appointments through member outreach and scheduling, as well as assisting care coordinators with scheduling all visits
• Answers incoming calls requesting services
• Participates in the collection and reporting of information as defined by the monthly reporting requirements
• Uses reason and logic to solve problems during the review process and maintains a positive, professional, and respectful attitude with peers and clients
• Researches and secures new telephone numbers to contact members
• Reviews and analyzes claims data in accordance with coordination for financial reports
• Works with clinical staff in the performance of all non-clinical/administrative tasks associated with the MCCW program
• If bilingual (primarily Spanish), assist with translation calls with care coordinators.
• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITEC).

Other Responsibilities:

• Adheres to the policies and procedures of Community Health Solutions
• Maintains strict confidentiality of client, company, and personnel information
• Demonstrates a strong commitment to the mission and values of the organization
• Adheres to company attendance standards
• Performs other duties as assigned

Supervisory Responsibilities: None

Competencies:

• Strong organizational and interpersonal skills
• Excellent written and verbal communication skills
• Detail oriented
• Ability to multi-task and work independently
• Strong competency in Microsoft Office products including Word and Excel

Qualifications:

Qualifications:

• A minimum of two (2) years of work experience in a medical office setting.
• Proficiency in data entry skills
• Strong customer service/telephone skills
• Medicaid experience a plus
• Bilingual (Spanish) preferred

Education and/or Experience:

• A high school diploma or equivalent is required. Knowledge of medical terminology is required.

Certificates, Licenses, Registrations:

• Certified Medical Assistant, Certified Community Health Workers

Computer Skills:

• Proficiency using software programs such as MS Word, Adobe, Gmail, Excel and Outlook

Environmental Factors/Physical Demands:

May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

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