Overview:
Now hiring a Education Outreach Representative-Medicare
Responsible for statewide education, outreach, and retention of Presbyterian Medicare Advantage members and acquisition of prospects. Represents Presbyterian in the community; networks, develops and manages relationships with key advocate agencies. Creates and conducts educational presentations for internal and external customers; responds to escalated inquiries requiring research and resolution of complex issues. Applies CMS and NCQA regulations and established PHP approved policies, procedures, and guidelines in all customer contacts, member initiatives, and communication materials.
How you belong matters here.
We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
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Full Time - Exempt: Yes
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Job is based Rev Hugh Cooper Admin Center
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Work hours: Varied Days and Hours
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Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Qualifications:
- High school diploma required; associates degree preferred. New Mexico State Health and HMO License required or obtained within 90 days of hire.
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Two to three years experience in a managed care organization with individual or employer group sales, preferably in Medicare Advantage plans, Medicare Supplements, and other senior or government programs.
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Requires three to five years customer service experience in health insurance, healthcare retention, sales, or marketing.
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Additional experience preferred in healthcare claims processing, provider network, or other background that would provide the skills needed for research and resolution of complex issues. Bilingual preferred.
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Excellent public speaking and presentation skills; demonstrated ability to communicate effectively in person, by phone, and in writing with all levels of internal and external customers and partners.
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Requires strong interpersonal, negotiation, organizational, multi-tasking, and prioritization skills.
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Ability to understand what and how work is to be done as well as why it is done.
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This level includes interpretation of data. Ability to understand, interpret, and explain complex plan details and basic medical terminology.
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Ability to work with and positively influence highly dissatisfied and irate customers.
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Must be able to work effectively as a team member and independently, and function well under pressure.
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Must be able to function effectively in a highly competitive Medicare product marketplace.
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Excellent PC skills; MS Office/Windows required; database experience preferred; experience with integrated data management systems.
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Requires detailed knowledge of State and Federal compliance standards regarding government programs and products and PHP goals.
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Must complete all required basic and advanced compliance training. Must be able to lift up to 35-70 pounds regularly.
Responsibilities:
- Organizes, facilitates, and conducts ongoing community outreach as well as prospect and member education events. Effectively communicates the program attributes, benefits, services, product changes, and regulatory requirements to a variety of audiences. Facilitates loyalty; proactively anticipates and manages customer expectations. Prepares training materials, including presentations, resource guides, evaluation forms, and visual aids. Reviews materials for consistency and quality, and obtains regulatory approvals. Obtains supplies and marketing materials to use during outreach activities.
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Provides year-round support for Medicare Sales Team with walk-in prospects, prospects who attend ANOC, New Member Education Sessions and community events in a highly competitive market. Work collaboratively to organize and participate with or on behalf of Medicare Sales Team at community events that target Medicare prospects.
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Networks, develops, and manages collaborative relationships with key contacts from external government and community advocacy agencies; researches and responds to advocate requests regarding complex situations. Supports internal departments with escalated benefit or service inquiries; internal departments to include Government Programs Administration, Medicare and Commercial Sales, PCSC, Enrollment, Appeals and Grievance, Member Design Program, , Quality, Pharmacy, Provider Network Management, etc.
- Plans and conducts service and business recovery initiatives; contacts members to increase participation at educational and special events.
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Completes all required training to remain current with state and federal regulations related to Medicare programs and PHS/PHP policies and procedures; maintains appropriate State of New Mexico licensure and certifications.
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All other duties as assigned.
Benefits:
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Maximum Offer for this position is up to: USD $32.17/Hr. Compensation Disclaimer: 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.