Job description

Why This Role is Important to Us:

Mass Health is returning to the standard annual renewal process on April 1, 2023. These roles are needed to support our current SCO/ICO members as they complete the Medicaid Redetermination process

What You'll Be Doing:

• Respond and effectively triage member phone calls
• Work with the Enrollment/Retention team to address the needs of members
• Provide timely and accurate information regarding member redetermination and retention process.
• Explain qualification standards, policies, and procedures to members; assist members in the completion of applications, forms, and reports when necessary; review and evaluate paperwork for completeness and accuracy.
• Understand and assure compliance to, and adherence with, Medicare & Medicaid enrollment regulations, and related CCA policies and procedures.

• Notify members, in accordance with CCA Policies & Procedures (which reflect Medicare and MassHealth regulations) of theirloss of CCA eligibility.
• Assist in the collection of supporting data and documentation relevant to the member and ensure copies of notices and documentation are filed in Members’ records.
• Cultivate and maintain collaborative relationships - with primary care site partners and community-based outreach/enrollment organizations - to engage their assistance in partnering with members.
• Meticulously document all member related interactions into CCA’s centralized electronic system, for the purpose of accurate tracking and analysis. Complete comprehensive grievance intakes when necessary
• Identify possible member issues, communicate resolution of the issue, and escalate accordingly
• Complete a Status Report for Supervisor and CCA Managers - Responsible for meeting departmental expectations, benchmarks, goals, and key performance indicators
• Connect members to MassHealth and other state agencies as appropriate.
• Responsible for acting in compliance with HIPAA, State, and Federal regulations when assisting CCA members

Other responsibilities and duties as assigned.

What We're Looking For:

• Associate degree or equivalent experience.
• BA/BS Degree preferred.
• Minimum Years’ Experience Required: 3-5 years
• Experience working with elders, irate callers, and disabled individuals in person /on the phone.
• Customer service and/or call center experience required
• Experience working with healthcare systems/services, and/or experience working with community organizations, social services and public resources.
• Experience working with Medicare & Medicaid eligibility requirements and enrollment related regulations and process
• Experienced in CRM or/ Market Prominence a plus
• Prior experience working in the health care industry front lines or medical setting preferred
• Experience working in a quality-focused environment with a rigorous quality assurance measuring program
• Must be passionate about serving others and able to show empathy to distress individuals
• Computer literacy a must, demonstrated ability to work
• Must be resilient and adaptable working in an environment that includes continuous change
• Proven proficiency working in a metrics, benchmarks and goals

Job Type: Temporary

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