Health Benefits Advisor

In response to changes in the American health care system, many states adopt mandatory Medicaid managed care initiatives in an effort to control medical costs and improve healthcare access for the low-income and uninsured populations. These programs encourage the use of preventive and primary services while managing the use of more expensive inpatient and emergency care services. PCGhas performed and sustains successful Medicaid managed care projects in several states throughout the US.  In these states, PCG's trained health benefits advisory team has become an essential liaison between the consumer or Medicaid recipient, state human service agencies and private HMOs. We service the products of the insurer while educating the consumer on how to manage risks and how to make informed choices regarding their insurance coverage.

Key Factors in our Success:

• Maintaining strong, positive working relations with state agencies, consumers and HMOs;
• Implementing strong outreach strategies to ensure the voluntary enrollment rates;
• Educating recipients to ensure full understanding of programs and their options;
• Utilizing a proven automated tracking system for call center operations;
• Providing a flexible process to accommodate reporting needs for all parties involved:State & Local Agencies, HMO, Providers, and recipients;
• Offering online reporting;
• Furnishing customized, online provider directories.

PCG understands our clients’ goals to reduce Medicaid spending without reducing or jeopardizing the recipient's quality of care. PCG's Medicaid managed care team is dedicated to helping states accomplish this mission.

HBA services provided by PCG include:

• Enrollment, Disenrollments and Transfer functions
• Auto Assignments
• Informal and Formal Grievance Resolution
• Call Center Operations
• Outreach and Education
• Provider Recruitment
• Education Material Development
• TPL Tracking and Reporting for HMO's
• Collaborate efforts with State Agencies for Marketing and Advertising Initiatives

Attachments

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