Government Programs Eligibility

4 weeks ago


Cambridge, Massachusetts, United States Cambridge Health Alliance Full time
Job Summary:

The Government Programs Eligibility & Business Office Manager plays a critical role in ensuring the seamless access and ongoing eligibility of PACE enrollees for MassHealth and Medicare. This position oversees business office operations, including payment account settlement and enrollment data management, while serving as an expert in the MassHealth and Medicare enrollment process and regulatory compliance standards.

Working closely with multiple teams within and outside CHA PACE, the person in this role tracks and reports MassHealth renewals, long-term care conversion, and Medicare enrollment for existing PACE participants who become eligible. They are also responsible for managing any ongoing government program enrollment issues, communicating progress on issue resolution or involuntary disenrollment processes to all necessary stakeholders, including government agencies, PACE staff, program participants and their families, and other relevant care representatives.

Alongside Health Plans Operations and Finance staff, the Government Programs Eligibility & Business Office Manager monitors participant self-pay, spend down accounts, and long-term care patient payment amounts. When applicable, they follow up on any accounts payable issues and monitor LTC vendor invoices for accuracy and resolution.

Key Responsibilities:
  • Expertise in MassHealth and Medicare enrollment process and regulatory compliance standards
  • Oversee business office operations, including payment account settlement and enrollment data management
  • Track and report MassHealth renewals, long-term care conversion, and Medicare enrollment for existing PACE participants
  • Manage ongoing government program enrollment issues and communicate progress on issue resolution or involuntary disenrollment processes
  • Monitor participant self-pay, spend down accounts, and long-term care patient payment amounts
  • Follow up on accounts payable issues and monitor LTC vendor invoices for accuracy and resolution

Requirements:
  • Bachelor's degree in business/healthcare administration or equivalent experience
  • Experience in government program operations (Medicare and MassHealth eligibility) highly desired
  • Highly organized, excellent written and verbal communication skills, proficient leveraging IT systems to increase overall organizational efficiency and effectiveness

About Cambridge Health Alliance:

Cambridge Health Alliance brings care to the people, serving vibrant, diverse communities and playing an integral role in improving health. As passionate advocates for the underserved, we actively partner with our communities to take on challenging public health issues and conduct important research to help reduce barriers to care. We believe that everyone deserves access to high-quality, convenient healthcare.

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