Member Financial Counselor

Job Summary:

The Member Financial Counselor will directly support ArchWell Health members with signing up for state and federal assistance programs to optimize benefits they are eligible to receive. This role will be member facing and require the counselor to travel and work within their assigned and Market to engage with members at centers. This role will require technological proficiency and the ability to competently navigate the requirements of the health plans, state and federal assistance programs. An ideal candidate will have strong attention to detail during significant data input, respond well to ongoing feedback from leadership, and have the ability to communicate effectively with seniors.

Duties/Responsibilities:

• Assist members in completing paperwork for eligibility determination, enrollment, and recertification of state and federal programs, including Medicaid, D-SNP, Medicaid and Medicare Savings Program (MSP), Low-Income Subsidy (LIS), Supplemental Nutrition Assistance Program (SNAP), Low Income Home Energy Assistance Program (LIHEAP), and Lifeline
• Evaluate, research and document financial histories of patients in relation to Medicaid and other state/federal program regulations
• Enter and update data into various internal and external systems (financial management system, Medical Eligibility Program database, etc.), including data to assist in the necessary capture for reporting
• Meet with members and/or guarantor on-site, by appointment or walk-in, or over the phone, to assist with Medicaid, Marketplace or other state/federal application process
• Contact providers, nurses, social workers, employers, banks, etc. to obtain appropriate medical, legal and financial information to complete Medicaid
• Support ArchWell Health Cost Share Assistance Program for assigned Market
• Other related duties as directed by financial program leader
• Exercise and maintain patient confidentiality by complying with all federal, state, and local statues or other agency regulations pertaining to confidentiality and patient’s right to privacy
• Use strict self-discretion and control in the disclosing of patient information in accordance with company policy and compliance regulations
• Make recommendations for process improvements to Financial Counseling leadership

Required Skills/Abilities:

• Strong working knowledge of Medicaid, SNP and assistance programs, financial counseling practices, eligibility requirements and procedures for multi-state and federal programs
• Strong understanding of state and federal assistance programs, including Medicaid, and managed care plan enrollment and participation requirements, with multi-state Medicaid experience preferred
• Ability to build strong cross-functional relationships to drive projects and initiatives to completion
• Ability to partner and communicate with stakeholders in a professional manner
• Strong organization and written communication skills

• Excellent problem-solving skills
• Proven performance results, decision making and judgement
• Strong PC skills with ability to navigate state benefit portals and eligibility systems
• Must understand medical insurance to be able to discuss and explain balances, deductibles, co-pays, co-insurance.  Ability to read and interpret an explanation of benefits (EOB).
• Ability to understand and present data
• Ability to communicate well with all levels of staff, providers, patient referral sources, and members
• Regular travel will be required within assigned Market (80%)

Minimum Qualifications:

• Bachelor’s degree preferred, or equivalent experience
• Valid, active driver’s license with access to a reliable vehicle for travel around the market (80%)
• Minimum of three (3) years of relevant experience required; this includes Medicare program experience and Medicare Advantage Special Needs Plan (SNP) eligibility and enrollment experience
• Experience with multi-site healthcare delivery organizations desired
• Experience with capitated risk-based reimbursement models strongly preferred
• Proficient in Microsoft Word, Excel, PowerPoint, Outlook
• Ability to learn and work with different software to perform duties of role, including Salesforce, Teams, and EMR systems Embodies and serves as a role model of ArchWell Health’s Values:
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.