This is a work-from-home position which requires residency in the State of South Carolina
 

Summary

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 “MCCW” 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 the 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).

Supervisory Responsibilities:   None

Competencies:

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

• 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 is 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 alphanumeric 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,g and lifting up to thirty (30) pounds.

Other Duties:

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee.  Duties, responsibilities, and activities may change at any time with or without notice.

• 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 by the Care Advocate Manager as the position develops.

Community Health Solutions is a drug-free, smoke-free workplace, and participation in random/post-incident drug testing is required.

At-Will Employment (South Carolina):
Employment with Community Health Solutions is “at-will.” This means that employment is for an indefinite period of time and may be terminated by either the employee or the employer at any time, with or without cause or notice, and for any reason or no reason at all, in accordance with South Carolina law. Nothing in this job description or any other document should be interpreted as a contract of employment.