AIDS Healthcare Foundation

Sales and Community Outreach Representative

US-GA-Atlanta
Req No
2017-6900
Category
Managed Care
Type
Regular Full-Time

Overview

Positive Healthcare, AIDS Healthcare Foundation's Managed Care Division, has provided people living with HIV quality health care since 1995 when it started the nation’s first Medicaid health plan for HIV-positive people living in Los Angeles. Today, Positive Healthcare cares for more than 7,000 lives in California, Florida and Georgia.

 

PHP (HMO SNP)

PHP is a Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries who are living with HIV and reside in Fulton County.

PHP is the first HIV-specific special needs health plan approved by the Centers for Medicare & Medicaid Services (CMS). This plan covers routine doctor and specialist office visits, emergency and urgent care, hospitalization, and more. It also includes a prescription drug benefit for no monthly premium.

 

Responsibilities

Essential Duties & Responsibilities

Includes the following.  Other duties may be assigned.

 

  • Represents PHP’s mission and core values to staff, stakeholders, collaborative associates, and government agencies.
  • Maintains knowledge regarding the current standards of HIV/AIDS care including HAART regiments and treatment of co-morbid conditions related to HIV/AIDS.
  • Creates a managed care sales marketing plan for the target areas within the Georgia region to increase sales for the Georgia managed care market.
  • Maintains extensive knowledge of the current Georgia Disease Management and Managed Care contractual language, Medicaid and Medicare systems, and private insurance formulary guidelines.
  • Coordinates with the Marketing Department, to produce managed care-marketing materials for the Georgia pharmacies, for local healthcare providers, regional and national scientific meetings.
  • Coordinates an Internet Web-Based managed care marketing plan with the Marketing Department and outside consultants.
  • Prepares presentations for local and statewide staff meetings.
  • Strictly follows CMS’s Chapter 2, Medicare Marketing Guidelines (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423). https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html
  • Maintains a marketing and managed care enrollment report on a weekly and monthly basis for discussion and analysis with the Managed Care Regional Sales Director.
  • Establishes and maintains sales relationships with physicians, AIDS service organizations, and community based organizations, etc. Makes sales calls on a routine basis, and creates on-going database with contact information of these potential referral sources.
  • Assists the managed care plan, in the resolution of provider or customer complaints. Assures all parties are satisfied with the outcome.   Reports results of interventions to the MCO Regional Sales Director.
  • Gives input into the development of managed care marketing and sales for the Georgia managed care plan.
  • Assures that the patient and provider satisfaction surveys are completed on a timely basis and that the interventions taken as a result of the surveys are appropriate.
  • Represents PHP on a local and statewide basis to discuss the managed care health plan. This includes, but is not limited to community led meetings, government agencies, faith based organizations and providers.
  • Maintains a presence at each of the regional offices in the area assigned at least quarterly and more often as needed.
  • Travels within and outside of the state of Georgia as necessary.
  • Assists patients with understanding the importance of medication adherence as well as guiding them through their respective managed care systems.
  • Provide community outreach and education to agencies in the HIV Community as well as generate awareness of the health plan through health fairs and participation in community activities/committees/meetings. 
  • Conduct one on one and group presentations of health plan benefits, exclusions, limitations and enroll interested members into Positive Healthcare Partners (Medicare Advantage Part D Special Needs Plan).  Explain the enrollment process thoroughly, member rights and plan policy and procedures.
  • Provide excellent customer service to potential and plan members on a wide variety of inquiries or concerns and facilitate expedient resolution.  Directs enrollee grievances or complaints to the appropriate personnel or departments for follow-up.
  • Participates in HIV-related community events and other venues for outreach.  Assists Enrollment & Regional Sales Director in ensuring that any applicable federal and state guidelines for participation in such community events are adhered to and that any required marketing approvals are obtained from the appropriate agency(ies).
  • Represents the organization in a professional and positive manner in the marketplace.
  • Meet or exceed monthly quotas for the Managed Care Plan.
  • Reports and other duties as assigned.

 

Supervisory Responsibilities

This job has no supervisory responsibilities.

 

Participation in AHF Meetings/Committees

  • Participates in various sales and operations Conference Calls
  • Attends Regional and Managed Care Staff Meeting (At least one per quarter)
  • Attends Annual Statewide Meetings
  • Participates in PHP committees as assigned.
  • Attends Managed Care Operations Meetings

Qualifications

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Education and/or Experience: 

  • Bachelor's degree (B. A.) preferred but not required.
  • Experience in the Healthcare field, Marketing and sales experience and/or training preferred. 
  • Managed Care Sales and/or other related Healthcare sales extremely helpful and desirable.

Computer/Software Skills & Abilities

To perform this job successfully, an individual should have knowledge of and proficiency in contact management systems; database software; spread sheets, presentation programs and Word processing systems.

 

Language Skills:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

 

Mathematical Skills

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.  Ability to apply concepts such as fractions, percentages, rations, and proportions to practical solutions.

 

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Other Skills & Abilities/Qualifications

  • Strong interpersonal communication skills.
  • Ability to work with minimal supervision.
  • Sensitivity to AIDS/HIV related issues and concerns.
  • Experience in health care benefits (Medicare, Medicaid) required.
  • Bi-lingual (English/Spanish) preferred.
  • Must have reliable transportation.

 

Required Certificates, Licenses, Registrations:

  • Valid driver’s license and proof of automobile liability insurance.
  • Must have current Georgia Agent License. If not currently licensed, must obtain within 90 days of employment. 
  • Must have Association of Health Insurance Plan (AHIP) Certification.

 

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