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Health Homes Advocate-Health Homes

Company: Kern Health Systems
Location: Bakersfield
Posted on: November 11, 2019

Job Description:

JOB SUMMARY:

This position reports to the Health Homes Program Supervisor. The Health Home Program Advocate will support their assigned Health Home Program Site in the distribution of incentives and support with oversight of various reports to ensure the care management staff are kept up to date on all enrolled members activities whether it be appointments, reconciliation of encounters to claim, hospitalizations, ER and UC use and discharges. This position will provide care incentive distribution and oversight of program reports and requirements at the site level.

Essential Duties and Responsibilities:



  • Distribution of incentives to qualified enrolled members per incentive guidelines for active participation in the HHP.
  • Ordering and tracking of incentives including daily reconciliation of gift cards.
  • Reconciliation of HHP services (Electronic Medical Records (EMR) to claims submission). Any discrepancy will be brought the site management attention and corrected before claims are submitted to KHS, the reconciliation will be done within 24 hours of a patient being seen.
  • Will monitor G-code reconciliation report for capturing of all missing claims for EMR hits.
  • Review member aging report and make sure the sites know who has not been seen in more than 45 days to outreach or she/he outreaches to these members to get them in.
  • Review daily inpatient report and make sure the site has a care coordinator assigned to members in hospital for contact and TOC.
  • Review Daily previous discharge reports to ensure assigned care coordinators are aware of discharges so they can contact member for TOC appointment within 48 hours of discharge.
  • Review ER, UC and Nurse Line reports and alert CC or CM of member calls for follow up. Eligible members on Nurse line report to be contacted by site staff or HHPA for initial appointment.
  • Monitor HAP for 90 completion and completed goals thereafter.




    Essential Duties and Responsibilities (Continued):


    • Knowledge of the healthcare industry and familiarity with managed care plan designs and benefits
    • Knowledge of the history, development and business case for the patient centered medical home model
    • Proficient in the use of multiple applications such as Microsoft Office
    • Possesses excellent written and verbal communication with contract providers and internal KHS staff to promote effective and timely coordination of care and dissemination of KHS policies and procedures.
    • A willingness to work effectively in a team
    • Collate, track and share data with the provider from the plan level
    • Provide member resources such as customer service related to the HHP
    • Responsible for maintaining assigned case load and member contacts as required by the program protocols
    • Keeps accurate, up-to-date documentation on members served in the program
    • Advocate for members when there is a problem in the service delivery system
    • Monitor all internal reports and work closely with the CB-CME site to ensure that all required program protocols are being completed on a timely manner.
    • Assists management staff in completing member services related special projects.
    • Organizes and maintains departmental files, records
    • Utilizes computer for detailed data entry
    • Completes calls related to patient satisfaction as directed by management
    • Engages in activities related to other clinical services initiates
    • Good Writing and Verbal skills are essential


      Employment Standards:



      Education: Bachelors degree, Medical Assistant (MA) Certificate, or 3 years of Case Management experience in the Health Care field required.

      Experience: Three (3) or more years of recent experience in customer service related field with a high degree of problem solving and decision making. Strong telephone and communication skills required. Preferred experience in a patient centered medical home.

      ** Bilingual Spanish/English Required.

      Productivity: Will be responsible for monthly productivity standard. Productivity will be tracked based on monthly encounter submissions.

      Knowledge of: Excellent customer service and telephone techniques and etiquette. Health Maintenance Organizations (HMO) desirable.

      Other:Possession of valid drivers license and proof of State required auto liability insurance. Required Travel Up to 40%

      Ability to: Work under pressure; work independently and manage multi-task responsibilities; be willing and able to assist and educate the member; intervene effectively in crisis situation on behalf of an upset, distraught, dissatisfied, confused or angry member; solve complex and comprehensive problems; organize and set priorities; adhere to state and federal timelines; have excellent communication skills both written and verbal and work in a rapidly evolving work environment.

Keywords: Kern Health Systems, Bakersfield , Health Homes Advocate-Health Homes, Healthcare , Bakersfield, California

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