"I am content with my placement and services through Hamaspik Choice."
W. L. Roscoe, NY
"I am in a residential facility on account of my sickness and I am content with Hamaspik Choice’s coverage."
D. L. Roscoe, NY
"Steve said Hamaspik Choice answered all his questions promptly. When he needed a hospital bed or a ride to a doctor you were always there, sometimes at the last minute."
"I have been with Hamaspik Choice for about 4 years and the services are pretty good. When I need to talk to my Care Manager, she calls me back. My Care manager has been very helpful."
R. Z. Callicoon, NY
“I appreciate the excellent job that Hamaspik Choice is doing on my behalf.”
D. M. Monticello, NY
“Everything is good with my Care Manager, and with Hamaspik Choice.”
E. E. South Fallsburg, NY
The Compliance Analyst will assist with implementing the Compliance Program, and will conduct Compliance Monitoring activities including auditing and investigating the plan’s operations to ensure compliance with all requirements. The Compliance Analyst will be responsible for overseeing continuous projects to assure operational compliance with regulations.
The position will include:
- Auditing and Monitoring of the plan's operations
- Research of regulations in collaboration with legal counsel
- Implementing updated policies and procedures
- Conducting staff trainings
- Develop internal protocol to assure compliance on multiple aspects of the plan’s operations
Candidate will have:
- Regulatory experience in the Medicaid Managed Care industry
- Experience with auditing and investigating company processes
- Experience with writing, developing and implementing managed care policies and procedures
- Knowledge of MLTC requirements
This position is responsible for gathering, assembling, formatting, and analysis of federal regulatory reports as well as other external reports. The ideal candidate will be responsible for high frequency reporting and analysis of internal Plan statistics, maintenance of databases, preparing documentation to support management in decision making, providing problem-solving support on revenue, and financial issues for the Medicare Advantage Plan.
- Prepare and review documentation and forms for regulatory filings
- Coordinate and facilitate intermediary audits and reviews of regulatory flings (Medicare) and assist in the development of re-openings based on disputed issues
- Develops new or revised reports to provide management with the information necessary to support organization growth and development.
- Responsible for developing models for financial forecasting and reporting functions
- Collects and analyzes data related to Medicare bidding, reserving, risk adjustment, reporting and other functions.
- Reconciling risk scores, identifying data reporting gaps and projecting risk scores for Medicare bid.
- Manage quarterly Medicaid State Reporting.
- Responsible for the financial analysis, including IBNR review, projections and monthly financial statements.
- Perform special projects as request by VP of Finance
Required Education and experience:
- 2 - 4 yer of related work experience in financial reporting, planning and analysis or equivalent.
- Experience in health insurance, healthcare administration, or management consulting. Preference given to those with Medicare or Government Programs related experience.
- Microsoft Excel at an advanced level (vlookup, hlookup, linking files, formatting tables).
- Ability to analyze, and critically appraise, financial statistics and reports
Hamaspik Choice MLTCP is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. UR Nurse will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services.
This position is responsible for the development of a person centered service plan/ plan of care based off of the assessment documentation completed by the visiting RN.
Some of the daily activities will include managing requests for medical services and renders clinical determinations. You will deliver timely notification detailing clinical decisions and provide intervention to decrease delays and denials.
Candidate works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. The Utilization Management nurse will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.
Candidate must be able to make decisions that are financially prudent, highly ethical, in compliance with all governing regulations, and demonstrate a commitment to our members welfare and well-being.
- $1,000 Sign-on Bonus (paid after the successful completion of the 90-day probationary period)
- Medical, Dental and Vision Insurance Coverage
- Company-paid Life Insurance, Long Term Disability Insurance
- Paid Time Off, includes vacation, holiday and sick pay
Hamaspik Choice is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to their race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by state or local law
We are seeking a Medicare Enrollment Agent to assist individuals in our coverage area through the important decision-making process of selecting our Medicare plan. Applicant must be available to work in New York State.
Responsible for growing Medicare Advantage enrollment volume by targeting Medicare beneficiaries that have dual eligible status (Medicaid and Medicare) while adhering to all mandates set for the in the CMS marketing and compliance guidelines as well as Hamaspik Choice's policies and procedures.
- Identify prospective enrollees and determine eligibility for participation in the D-SNP Medicare product
- Guide consumers through the health insurance policy selection and application process and serve as subject matter expert for health insurance enrollments
- Quickly grasp new concepts and product offerings
- Learn and adapt quickly, while following Hamaspik Choice internal policies and procedures
- Comply with Federal CMS and State legal requirements and standards
- Be the face individuals can trust at the consumer level, and serve as a brand ambassador for the organization in the communities of the Hamaspik Choice service area
- Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies—this includes providing enrollees with all corresponding materials and documentation
- Conduct and participate in outreach efforts as required
- Attend and participate in sales meetings, training programs, conventions, and special events to promote product education and awareness for the dual eligible population
- Drive continuous improvement throughout the sales process, raising opportunities for higher commissions
- Promote retention and minimize rapid disenrollment by providing accurate, consistent and timely service and follow-up
Specific Knowledge, Skills, and Abilities:
- Excellent customer service and communication skills
- Good organizational, writing, communication, and interpersonal skills.
- Negotiation and closing skills
- Ability to deal with problems involving several variables in standardized situations.
- Ability to solve practical problems and deal with a variety of situations where only limited standardization exists.
Required Education, Experience, and Licenses:
- High School Diploma
- 2+ years of health care or insurances sales experience
- Passing grade of the NYS Insurance Exam
- NYS Accident and Health Insurance Agent License
- Health, Vision and Dental Insurance
- Employer paid long term disability and life insurance
- Paid time off - includes vacation, holiday and sick pay
Hamaspik Choice is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to their race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by state or local law.
• Develop and implement an annual Quality Management work plan, and lead Quality Assurance initiatives including the monitoring and evaluation of the quality of all programs.
• Implement and coordinate the quality committee structure, as required by regulation.
• Lead HEDIS/QARR submissions, and lead quality improvement projects, designed to improve outcomes for enrolled members.
• Implement initiatives to conduct member satisfaction surveys.
• Develop and implement processes to monitor the quality of network providers.
• Responsible for all incident management including the investigations and corrective action plans of all incidents within the company and its providers.
• Oversee all quality related reporting requirements.
Education- BA required in healthcare, MA preferred.
Experience- 5 years' experience within a managed care plan, with experience leading Quality Assurance activities in Medicaid and Medicare health plans preferred.
Responsibilities include building and maintaining a successful working relationship between network providers to ensure a geographically broad access and stable network. Candidate will also negotiate cost effective fees, confirm service capability, respond to provider inquiries, and educate providers on contract expectations, processes and paperwork. Individual must be a quick learner, able to multi-task, and have excellent communication and organization skills.
The Compliance Analyst will assist with implementing the Compliance Program, and will conduct Compliance Monitoring activities including auditing and investigating the plan's operations to ensure compliance with all requirements. The Compliance Analyst will be responsible for overseeing continuous projects to assure operational compliance with regulations.
The position will include:
• Auditing and Monitoring of the plan's operations
• Research of regulations in collaboration with legal counsel
• Implementing updated policies and procedures
• Conducting staff trainings
• Develop internal protocol to assure compliance on multiple aspects of the plan's operations
Candidate will have:
• Regulatory experience in the Medicaid Managed Care industry
• Experience with auditing and investigating company processes
• Experience with writing, developing and implementing managed care policies and procedures
• Knowledge of MLTC requirements
The Home Care Specialist is responsible for the coordination of home care benefits which include PCA, CDPAS, HHA and skilled services to secure coverage.
Responsibility includes coordination for new members, existing members as well as ongoing communication with all home care providers.
Candidate must be able to multi-task and have excellent communication and organization skills.