MassHealth Enrollment Specialist

4 weeks ago

South Boston, United States Harbor Health Services Full time

Harbor Health Services is seeking a talented MassHealth Enrollment Specialist to join our team at the Elder Service Plan in Mattapan, MA. Harbor Health also operates two Programs for All-Inclusive Care for the Elderly(PACE)/Elder Service Plans in Mattapan and Brockton, providing comprehensive healthcare, transportation and social services for more than 580 frail elders who continue to live with dignity and independence in the community. Harbor Health offers an excellent, comprehensive benefits package including Health, Dental, Vision, Life, & Disability insurance, 403b Savings Plan, Generous Paid Time Off plus 11 additional Holidays and much more Role: The MassHealth Specialist is valued member of a marketing and enrollment team with a passion for bringing excellent healthcare services to older adults in our community. The MassHealth Specialist is responsible for ensuring that the initial MassHealth Applications are complete for all new PACE (Program for All-Inclusive Care for the Elderly) applicants. The MassHealth Specialist works directly with participants and family members, along with various departments in the Elder Service Plan (ESP) and MassHealth and plays a key financial role in the PACE enrollment process. Responsibilities: Strategizes with the enrollment team and participant(s)/caregivers to determine a financial path to enrollment. Engages with prospective members in a high-volume environment and customizes a timely path to enrollment while utilizing sales skills and discovery techniques to achieve quarterly enrollment goals. Responsible for all stages of the MassHealth application process, from initial financial meeting through MassHealth approval within enrollment deadlines and ensuring compliance with all state and federal regulatory requirements. In conjunction with the applicant and care partners, develops and communicates the timeliest path to enrollment which includes providing guidance using subject matter expertise. Tracks and follows-up with prospective members in CRM (Customer Relationship Management) software. Responsible for achieving weekly and monthly MassHealth enrollment metrics. Uses consultive sales techniques to consistently engage applicants during the lengthy enrollment process. Assesses current and anticipated income and asset levels to determine likely enrollment date and when/if outside counsel is required to obtain MassHealth approval. Maintains engagement during the lengthy sales process and forecasts likely enrollment dates and supports achieving monthly program enrollment goals. Coordinates collection of required documents (from participant/family/financial, etc.) and ensures submission to MassHealth to complete the application. Provides ongoing feedback to applicants and, when involved, referral sources, financial, and legal consultants, regarding likely MassHealth decision making, potential delays and opportunities for approval; works with all parties to develop timely path to enrollment. Interacts significantly with outside agencies including attorneys, guardians, social service agencies and other referral sources to ensure applications are submitted in a timely manner and all required follow up is completed through MassHealth approval. Responsible for developing and maintaining independent relationships with designated PACE MassHealth staff to facilitate smooth communication and successful enrollment. Meets with participant and family members in their place of residence or at other off-site offices to review financial components of Enrollment as needed. Ensures that participants and family members complete Income Verification forms. Interacts with participants and caregivers in a manner that adheres to the highest standards of care and professionalism. Requirements: Bachelors Degree in related field (preferred) or Associate degree with 2 years of related work experience or four years or more of experience in accounting or similar business-related field High level (3 years) of experience in finance or banking, MassHealth enrollment, accounts receivable or health insurance setting preferred Strong understanding of life insurance, health insurance, or banking industry Strong aptitude for sales Experience and/or desire to work with an Elder population preferred Intermediate or higher skills in Microsoft Office 365: Word, Excel, and Outlook and Teams Experience using CRM software preferred Excellent time management skills and ability to manage multiple deadlines simultaneously Proven problem-solving skills Excellent verbal and written communication skills and customer service skills Experience working with MassHealth or insurance preferred Bilingual a plus (Portuguese, Haitian Creole, Spanish or other language) Must be able to travel between all Harbor sites, off site locations and participants homes in a timely manner and work occasional evening when needed All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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