Disenrollment And Retention Specialist

Job Details

Level
Experienced

Job Location
ACA/NY HQ - New York, NY

Position Type
Full Time

Education Level
4 Year Degree

Salary Range
$31.50 - $37.30 Hourly

Travel Percentage
Up to 50%

Job Shift
Day

Job Category
Nonprofit - Social Services

DESCRIPTION

POSITION SUMMARY

The Disenrollment and Retention Specialist will be responsible for overall disenrollment functions related ACA/NY membership. The Specialist will serve as a subject matter expert for Care Management on Health Home Care Management disenrollment regulation, internal process and any related compliance matters. Working closely with the Care Management team, Care Connection, Compliance and Quality Assurance, the Specialist will also use best efforts to retain members in our CCO when appropriate.

ACA/NY is a 501(c)(3) not for profit organization that has been designated as a Care Coordination Organization/Health Home (CCO/HH) by New York State. ACA/NY is dedicated to meeting the needs of people with Intellectual and Developmental Disabilities by providing comprehensive care management and coordination of service. ACA/NY supports 25,000+ people in its program with support services spanning New York City, Long Island, and the Lower Hudson Valley.

DUTIES AND RESPONSIBILITIES

• Processes member change requests and CCO-2's for ACA/NY.
• Supports the completion of all documents related to disenrollment from ACA/NY.
• Demonstrated ability to manage workload and drive issues to closure in a timely manner with minimal supervision.
• Subject Matter Expert on disenrollment process for care management services/Care Coordination Organizations including components required to transfer to another CCO, move out of catchment, move to other non-qualified settings or comprehensive care management programs, loss of eligibility and loss of Medicaid.
• Completing a final verification that all quality and compliance components are completed prior to submitting a CCO2
• Promptly answer emails and calls and provide timely support to Care Management with related guidance on CCO2/Disenrollment process to meet monthly deadlines.
• Remain current on all statewide policies and procedures related to enrollment and disenrollment functions.
• Coordinate activities and projects related to loss of eligibility such as for members with missing Level of Care (LCED), Loss of Medicaid, Loss of Eligibility and other disqualifying situations.
• Coordination of CCO transfer cases with other Care Coordination Organizations and serves as point of contact for ACA/NY for this function.
• Responsible to conduct agency wide retention activities for CCO transfers and tracks the outcomes and success of retention efforts.
• Monitors and identifies trends in disenrollment.
• Tracking and monitoring all aspects of the disenrollment process and being able to identify where someone is in the disenrollment process.
• Notifying leadership of trends with disenrollments, if not already identified.
• Verify the OPWDD CHOICES Monthly Roster related to disenrollments and share information with leadership, as appropriate.
• Coordinate Initial Level of Care Decision (LCED) for CCO transfers, if not available at the time of transfer (for outgoing transfers).
• Review all Inactive and on hold prospective members for quality assurance
• Perform other duties as assigned.

QUALIFICATIONS

QUALIFICATIONS
• A Bachelor of Arts or Science degree plus two years of relevant experience; OR a Master's degree with one year of relevant experience.
• One-year experience completing intake and enrollment for OPWDD supports and services, strongly preferred.
• Demonstrated knowledge regarding access to member benefits (e.g. Medicaid), preferred.
• Experience using OPWDD's CHOICES system, a plus.
• Absolute sense of integrity and personal commitment to serving people with I/DD and their families.
• Excellent interpersonal, communication organization and demonstrated ability to manage multiple tasks simultaneously.
• Ability to work autonomously.
• Demonstrate professionalism, respect, and ability to work in a team environment.

WORK ENVIRONMENT

This job operates in a hybrid office environment which includes work performed at ACA/NY office hub sites and outside of the ACA/NY office setting. This job also requires field work as deemed necessary by the needs of the department.

This role consistently uses standard office equipment such as computers and phones in remote and office-based settings. This role also intermittently uses standard office equipment such as photocopiers, filing cabinets and fax machines in office-based settings. If such equipment is not available within remote locations, office visits will be necessary to support with these functions.

The noise level in the work environment is usually moderate. Travel to off-site locations required; therefore, the incumbent must be comfortable driving or using various forms of public transportation to reach destinations.

PHYSICAL REQUIREMENTS

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; stoop, kneel, and crouch. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.

AAP/EEOC

ACANY provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, the organization complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, training, and all other legally protected classifications.