Medicare DSNP Redetermination Coordinator

Site: Mass General Brigham Health Plan Holding Company Inc.

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.

The Redetermination Coordinator helps members who have lost MassHealth coverage get essential documents to EOHHS to regain MassHealth coverage. The Coordinator will also help with annual MassHealth renewals. This Coordinator will also help with DSNP enrollment. The idea candidates has experience with QNXT and EAM software.

Job Summary

Responsible for outreaching to members to assist them with the Medicaid Enrollment Redetermination process. This position is responsible for monitoring and optimizing processes related to Enrollment Redetermination.

Essential Functions
-Monitor and analyze health plan eligibility related to the Medicaid Redetermination and deeming process.
-Deliver an exceptional member experience via both telephonic and written outreach. Assist members with the Medicaid Redetermination process for our DSNP plans by explaining eligibility requirements and applicable forms.
-Collaborate with internal departments including but not limited to Sales Customer Service and Clinical to ensure seamless coordination.
-Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve member satisfaction.
-Support the creation and maintenance of health plan policies procedures and workflows to ensure compliance with regulatory requirements (e.g. CMS Medicaid Medicare state and federal laws).
-Monitor and document member outreaches.
-Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment.

Education

• Bachelors Degree (experience can be consider in lieu of degree)

Experience

• At least 2-3 years of experience in Medicaid redetermination required
• At least 2-3 years of experience in healthcare operations health plan management or a related field required
• At least 1-2 years of experience in the Health Insurance Industry preferred

Knowledge Skills and Abilities

• Excellent customer service and communication skills both verbal and written.
• Proficient in Microsoft Office: Word and Excel.
• Previous experience in s member-facing environment.
• Ability to identify trends monitor performance and implement process improvements.
• In-depth knowledge of Medicare Advantage or DSNP health plan enrollment operations.
• Strong attention to detail.
• Skilled in problem-solving with the ability to troubleshoot issues and develop actionable solutions.
• Excellent teamwork and relationship-building skills with the ability to collaborate effectively in a fast-paced and dynamic environment with individuals from varied backgrounds.
• Ability to manage multiple projects and tasks simultaneously while maintaining organizational priorities.

Working Conditions

• This is a remote role that can be done from most US states but candidates familiar with Massachusetts EOHHS requirements is preferred
• This is a full-time position with a schedule of 8:30 AM to 5:00 PM EDT

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$25.00 - $35.77/Hourly

Grade

5

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

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