The Member Advocate Specialist (MAS) has direct oversight for the advocacy of members included but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attends health fairs and community events, as needed.

PRIMARY JOB RESPONSIBILITIES:

• Facilitate the delivery of preventive dental services for eligible members every six months beginnings six months of age.
• Facilitate the delivery of preventive dental services for new members within 90 days of enrollment.
• Collaborate with other field-based advocate specialists, Outreach Coordinators, and marketing department in the development of generic and customized outreach strategies for increasing dental access rates.
• Coordinate with community engagement of health plan and clients.
• Collect, compile and analyze information gleaned from outreach initiatives/events in order to determine impact, and recommend changes that may make future outreach projects more effective.
• Establish and maintain community relationships that provide for participation in health care initiatives and programs to create dental awareness.
• Understand the cultural and socio-economic characteristics of their region(s).
• Develop a strong presence in local communities through partnering with organizations that advocate for and serve low income children.
  • These relationships will aid in the member advocate's ability to refer members to community resources that can accommodate members' needs if the services are not medically necessary covered dental services.
• Assist members, either in person or via telephone, with writing complaints.
• Responsible for monitoring complaints through completion.
• Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care/within 28 days for routine care in NY).
• Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs.
• Manage all aspects of the dental home process in their region.
  • This includes tasks such as assisting members with finding a dental home, coordinate case management for various populations including special needs and Children of Migrant Farm Workers (TX only), maintaining the data for reporting dental home activities, and coordinating outreach efforts.
• Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination and case management performance measures to DentaQuest management.
• Identify disparities, opportunities for improvement and recommended solutions.
• Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP and Frew guidelines (for TX only).
• Adhere to DentaQuest business processes.
• Other duties as assigned.

Member Advocate Specialist NJ/NY

• Collaborate with New York customer service management, NY quality manager, NY client and provider engagement management, marketing, data analytics, and others to achieve QARR metrics.
• Develop and implement member outreach and education programs in New York.
• Responsible for event set up and breakdown, travel in and out of state for events (NJ), all NY counties.
• Weekend events/works, and travel required/involved 50% of the time.
• Compile and submit required QARR to management/analyst and other required reports (as defined internally or contractually).

Member Advocate Specialist TX

• Collaborate with DentaQuest management, internal departments, state & local agencies and HHSC clients to plan, evaluate and implement activities to improve access and appropriate care to members.
  • This includes making recommendations on changes that may improve either the care provided, or the way care is delivered.
• Ensure members receive educational materials upon enrollment regarding the services available through the Texas Health Steps program and how to obtain them.
• Educational material also includes information on:
  • Member's rights and responsibilities
  • The complaint processes
  • The appeal processes
• Medically necessary covered services available to them, including preventive services
• Non-capitated services (benefits that are excluded from medically necessary services such as transportation)
• Assist Children of Migrant Farm Workers receive prompt delivery of service, as they might transition into and out of the dental program more rapidly than the general population.
  • This includes coordinating with their provider to make certain they receive preventive dental services prior to leaving Texas ("accelerated services") if their routine checkup is scheduled after they leave Texas.

• Bachelor's degree and/or 3 years of related experience in healthcare, advocacy or customer service.
• Demonstrated proficiency in claims processing and issue resolution.
• Knowledge of clinical and industry terminology and procedures.
• Demonstrated commitment to health and wellness.
• Self-motivated, and ability to work with little supervision.
• Strong analytical skills.
• Strong problem-solving skills and the ability to make independent decisions.
• Strong written and oral communication skills.
• Knowledge of general computer software. (Outlook, Excel and MS Word)
• Ability to communicate in an active office environment.
• Ability to travel throughout the State of Texas/State of New York as needed, including travel to other DentaQuest offices located in other states.
• Ability to efficiently operate all job-related office equipment.
• Ability to communicate via telephone and in writing.
• Ability to read and view computer screen.
• The department is in a wheelchair accessible building.
• The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.

Preferred:

• Registered Dental Hygienist
• Bilingual language skills preferred.
• Experience working in a managed care environment is preferred.
• Creativity in promoting events and implementation of events is preferred.
• Knowledge of healthcare advocacy activities is preferred
• Community Engagement Experience