Member Financial Counselor - MST & PST Time Zone

Job Summary The Member Financial Counselor will directly support ArchWell Health members with signing up for state and federal assistance programs to aid members in optimizing benefits they are eligible to receive, in addition to providing support for member finance inquiries for ArchWell Health and non-ArchWell Health medical bills. This role will require technological proficiency and the ability to competently navigate the requirements of the health plans, state and federal assistance programs. This role will have a significant data input component to ensure success of the program is captured and understood across Centers and Markets. It is a professional role where ongoing feedback will be provided and working closely with the Member Financial Counseling leadership is a requirement. Member Financial Counselor Duties/Responsibilities Connect with members over the phone to assist in completing paperwork for eligibility determination, enrollment, and recertification of state and federal programs; including but not limited to Medicaid, D-SNP, Medicaid and Medicare Savings Program (MSP), Low-Income Subsidy (LIS), Supplemental Nutrition Assistance Program (SNAP), and Low Income Home Energy Assistance Program (LIHEAP) Provide member support in a contact center environment, meeting established productivity, quality, service, and compliance standards while delivering effective solutions that achieve desired member outcomes, support financial well-being, and enhance the overall member experience. Intake and initiate inbound and outbound calls with members to provide education, resolve benefit-related concerns, and identify opportunities for enhanced coverage. Proactively identify members who are eligible for the programs available to reduce member financial responsibility. Receive inbound calls from members during established coverage windows. 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.) to capture necessary reporting information. Contact physicians, nurses, social workers, employers, banks, and others to obtain appropriate medical, legal and financial information to complete Medicaid applications. Support ArchWell Health Cost Share Assistance Program. Exercise and maintain patient confidentiality by complying with all federal, state, and local statutes or other agency regulations pertaining to confidentiality and patient’s right to privacy. Perform other related duties as directed by financial program leader. 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, managed care plan enrollment and participation requirements, with multi-state Medicaid experience preferred. Excellent verbal communication and active listening skills, with the ability to conduct effective member conversations, assess needs, provide education and guidance, and influence positive member outcomes. 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, and 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. Occasional travel required (5‑10%). Minimum Qualifications Bachelor’s degree preferred, or equivalent experience; H.S. diploma or equivalent required. Minimum of 3 years experience related to Medicaid and other assistance program eligibility required. Advanced working knowledge of Medicaid, Medicare Advantage, and other state and federal benefits programs serving seniors, including eligibility requirements, enrollment processes, benefit coordination, and plan selection. Ability to independently guide members through benefits counseling and enrollment activities. 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 eCW (eClinical Works). 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 Equal Opportunity Employer 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. #J-18808-Ljbffr ArchWell Health