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.

Essential Duties and 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:

• 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:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. 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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