Medicare Advantage and DSNP Enrollment Analyst
Medicare Advantage and DSNP Enrollment Analyst
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$ 62400 - 90750
1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D-SNP Enrollment.Duties and Responsibilities:
-Monitor and analyze Medicare Advantage and D-SNP Enrollment operations to ensure timeliness accuracy and compliance internally. Collaborate with vendor partners to monitor and analyze enrollment reporting.
-Review track and communicate key performance indicators (KPIs) related to compliance timeliness and accuracy.
-Work closely with internal departments including but not limited to Sales Finance Customer Service Claims IT Product Marketing STARS leadership and Digital Services to ensure seamless coordination and integration of enrollment operations.
-Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows reduce costs and improve member satisfaction.
-Assist with the implementation and management of new health plan products or changes to existing plans.
-Support the creation and maintenance of health plan policies procedures and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
-Provide audit support both internal and external and support the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts.
-Create and update Enrollment and Premium Billing reports. Identify trends recommend actions and escalate to leaders as appropriate.
-Performs other duties as assigned
-Complies with all policies and standards
Qualifications
Qualifications
- Bachelors Degree required; experience can be substituted for years of experience
- At least 2-3 years of health Insurance or Healthcare Industry experience required
- Medicare experience preferred.
- Massachusetts Medicaid experience preferred.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$62400.00 - $90750.40/AnnualGrade
6EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Employment Type
Full-Time
