MMM Medicare and Much More

Job Description

MMM of Florida, a proud member of the Innovacare Health family of companies, a powerful combination and the foundation upon which we’re expanding. Innovacare Health is the 9^th largest Medicare Advantage provider in the U.S. MMM of Florida is a licensed HMO, NCQA Accredited that serves individuals enrolled in Medicare Advantage plans.. Join us, this is an exceptional opportunity to do innovative work for the benefit of those we serve.

Position Description

This position is responsible for conducting seminar and in-home sales presentations to eligible Medicare beneficiaries. The Outside Sales Representative presents information about MMM to interested persons for which we have received a valid written authorization or a recorded phone call, and assists them to enroll after the seminar or 1:1 presentation. The Outside Sales Representative is responsible to conduct follow up calls according to CMS rules and regulations.

Responsibilities:

1. Primary job responsibility is to conduct presentations to potential prospects either by In-Home Visits or Seminars to close sale(s).
2. Generate leads through referral development, doctor’s visits, or follow up on direct mail or other direct response marketing.
3. Qualify leads and set appointments for in home visits.
4. Network to establish and maintain relationships with community contacts, providers, members and others who may refer potential leads.
5. Responsible for sales results in their areas. Results are monitored by an “audit” system.
6. Sales Representatives are independent and must manage the area to meet the companies’ objectives.
7. Create In-home reports, leads results & provider visits report and submits these reports daily to Sales Supervisor and Sales Coordinators before 7:45am.

Compliance:

1. Responsible to do presentations and fill out applications based on CMS, MMM and our regulators Rules and Guidelines.
2. Learn new policies and procedures and keep updated information of regulations related to Compliance and can comply with them.
3. Is responsible to maintain their commissioner licenses and driving licenses up to date.

Application Processing:

1. Assist the potential member in completion of the application and selection of a PCP, as necessary. Indicate such assistance on the application as appropriate.
2. Check all applications for completeness and accuracy before the member signs it.
3. Summit all applications and paperwork to the sales coordinator within 24 hours of member’s signature.

Education and Experience:

• Associate’s degree or equivalent from two-year College or technical school.
• Minimum one-year sales experience in health care sales, preferable.
• Previous experience working with seniors and/or disabled population (nursing, teaching, and social work)

Licenses and Certifications:

• The employee must have a valid driver’s license and should demonstrate a satisfactory record of safety.
• Must approve CMS Test with a minimum score of 80% to obtain the Commissioner HMO license.
• HMO License (215/220 Health, Life, Variable Annuities) is required.

Language

• Bilingual Spanish or Creole and English

Job Type:

• Full-time

 Locations:

• Miami-Dade, Broward, and Palm Beach County

Apply:

• To apply for this position, please submit your resume to our recruiter at careers@mmm-fl.com

Job Description:

MMM of Florida, a proud member of the Innovacare Health family of companies, a powerful combination and the foundation upon which we’re expanding. Our mission to provide greater care for our members and enhance the health for our communities is the driving force that brings us to work each day. We believe in embracing new ideas and challenging ourselves. A Florida licensed HMO that serves individuals enrolled in Medicare and/or Medicaid. Join us, this is an exceptional opportunity to do

innovative work that means more to you and those we serve.

MMM of Florida is seeking a Provider Integrity Analyst for their Miami Dade area office. Ideal candidate

will work with the analytics and operations team on various projects, or continuing operations, requiring

both automated and manual investigation of issues such as: membership, revenue reconciliation, claims

processing and medical expense, and provider network.

Primary Responsibilities:

• Create and modify operations and clinical recurring and ad-hoc data using Microsoft: Access,
• Excel and SQL Server, SSIS, and various Business Intelligence (BI) tools such as SMART
• Analytics, POWER BI, and Business Objects
• Responsible for collaborating with internal and external report owners to ensure reports are prepared timely, accurately and completely
• Works with and validates enrollment, claims, reimbursement and expense, provider and clinical data.
• Evaluates and presents information in a manner that will facilitate management’s understanding of the results and impact
• Effectively gathers and analyzes data for trending, tying data to business operations and making recommendations for action

• Develop and manage data mining and data pulls from multiple data sources into designated SQL servers, Access, and Excel
• Analyzed data and created business reports, including design and development of multiple service management and regulatory reports and dashboards, utilized automated updates, dynamic charts, formulas, and parameterized reports

Required Qualifications:

• BA / BS in business or specialty of functional area or equivalent related work experience
• 3+ years of experience in collecting, analyzing and presenting data and recommendations to

• management
• Strong proficiency in Microsoft Excel and Access, SQL server, including skills in writing Excel or
• Access VBA, stored procedures, SQL queries and T-SQL code
• Experience creating and presenting technical information verbally and in written form

Preferred Qualifications:

• Healthcare experience within a managed care and / or hospital setting
• Knowledge of clinical indicators, measures and terminology
• Data analysis, cost management and trending experience
• Programming skills (writing SQL code; creating Excel macros)
• ETL and SSIS knowledge
• Demonstrated critical thinking and decision-making skills
• Demonstrated ability to prioritize and manage multiple tasks

Job Type:

• Full-time

Experience:

• Provider Integrity: 8 years (Required)
• Provider Contracting: 8 years (Required)
• claims processing: 7 years (Required)
• SQL: 8 years (Required)
• claims reimbursement: 8 years (Required)
• Provider and Networking: 8 years (Required)

Education:

• Bachelor’s (Preferred)

Language:

• Bilingual Spanish (Preferred)

Innova Care Health, Inc. is a leading provider of managed healthcare services in North America. Through two primary avenues of care, Provider Networks and Medicare Advantage, they are committed to quality healthcare by creating models that are cost-effective and fully integrated with advanced technologies.

The company is a leading Medicare Advantage organization providing healthcare-related services in Puerto Rico since 2001 and most recently entering the Medicaid market as well.

This organization operates a medical service organization, which coordinates care through a network of 27 independent physician associations and over 2,900 primary care physicians.

Additionally, it operates two Medicare Advantage plans, the Island’s only NCQA-accredited health plans, which serve 200,000 members on the Island with a network of more than 7,500 providers.

MMM of Florida, an affiliate of the Company “and subsidiary of Innova Care” is seeking qualified Customer Service Representatives with extensive experience in the area of managed care / health plan setting for their new start-up operations in the Miami Dade, Broward and Palm Beach counties.

Position Description:

This position is responsible to serve as a primary liaison between enrolled Medicare beneficiaries and MMM of Florida for the purposes of member and provider education, issues resolution, and customer satisfaction.

Essential Duties and Responsibilities:

• Employee will be trained in different skills, in order to support departmental initiatives with staffing needs.
• Employee will be assigned to support inbound and outbound contacts. Support may include but not limited to: Part C Members calls, Pharmacy Member calls, and outbound Campaigns.
• Assures coverage of Customer Service contacts during operating hours.
• Register member and provider contact in system as applies.
• Accomplish established metrics by the Contact Center Management on a daily, weekly and monthly basis.
• Forwards performs and/or processes orientations regarding disenrollment, cancellations, reimbursements, outbound calls, Member satisfaction surveys, etc.
• Maintain itself in continuous learning environment with updated information obtained in trainings, emails, one on one’s, staff meeting and any other way.
• Manage CTI system in a daily basis.
• Report any unusual situation identified at the time of the member and/or provider contact.
• Manage and identify CMS calls.
• Manage contacts requesting interpreter services for foreign languages.
• Special projects as assigned.

Education and Experience:

Associate degree in health, business related field or comparable experience. Have a minimum of 2 years experience in healthcare and/or Contact Center environment. Health plan customer service experience and a license as an insurance agent, service representative, customer representative, or limited customer representative preferred. Good communication, interpersonal and problem-solving skills.

General Abilities and Knowledge:

• Computer literate, preferably in the following applications: Word, Excel and Outlook. Ability to respond to a high volume of work and maintain a polite and professional manner at all times.
• Able to function with frequent interruptions.
• Ability to prioritize workloads for maximum efficiency.
• Customer Service Skills: practicing, valuing and supporting service to both internal and external customers.
• Time Management Skills: establishing priorities and accomplishing tasks in a timely manner.
• Team Work: ability to work in a team environment to create solutions to problems.

General Skills:

• Have strong interpersonal skills.
• Excellent verbal and written communication skills.
• English and Spanish literate.

Language Skills:

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers.

Mathematical Skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written or oral form, detailed but not complicated. Ability to deal with problems involving few concrete variables in standardized situations.

Physical and Mental Demands:

• Position requires sitting and standing associated with a normal call center environment. Regularly talks and hears.
• This position requires that weight be lifted or force be exerted up to 10 pounds.

Environmental and Working Conditions:

Working on normal call center environment is required. The noise is typically moderate. Evening or weekend work, as necessary. Working flexible work hours; depending operational needs.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Job Type:

• Full-time

Experience:

• Call center: 2+ years (Preferred)
• Customer Service: 2+ years (Preferred)

Education:

• Associate (Preferred)