DSNP MassHealth Eligibility Representative

massgeneralbrigham; Somerville (MA); Hybride; USD 55 000 - 70 000; Plein temps

Résumé du poste

Mass General Brigham Health Plan is seeking an Enrollment Specialist to help MassHealth applicants navigate the enrollment process in a hybrid role based in Somerville, MA. You will outreach to Dual Eligible prospects, explain eligibility requirements, and guide them through forms and steps, collaborating with sales and external brokers as needed.

The ideal candidate has MassHealth application experience, 2–3 years in sales/healthcare/insurance, and strong communication skills in English

Qualifications

• At least 2–3 years of experience in sales, healthcare, or insurance with a focus on Government Markets.
• At least 1–2 years of experience with MassHealth Eligibility and Application Process preferred.
• Bilingual (Spanish/English) preferred.
• Familiar with HIPAA and healthcare regulations to ensure compliance.
• Experience with call center tools and CMS/state guidelines is a plus.

Responsabilités

• Analyze prospect eligibility related to Medicaid and Medicare enrollment.
• Keep up to date on Medicaid and Medicare requirements.
• Work with SCO & One Care prospects identified for enrollment with MGBHP.
• Deliver an exceptional prospect experience via telephonic and written outreach.
• Assist prospects with the Medicaid & Medicare process by explaining eligibility requirements and forms.
• Collaborate with internal team and external brokers to manage pipeline cases.
• Identify process bottlenecks and suggest improvements to enrollment workflows.
• Support policy and workflow documentation to ensure regulatory compliance.
• Monitor and document member outreaches in the CRM system.

Connaissances

Bilingual Spanish/English

MassHealth experience

Customer service

Regulatory knowledge

Travel ability

CMS guidelines familiarity

Formation

High School Diploma or Equivalent

Outils

CRM software

Call center software

Description du poste

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.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

The position is primarily assisting folks who need MassHealth, assisting them to apply for the first time, renew, or apply for waivers. The ideal candidate has MassHealth application experience and knowledge.

Responsible for outreaching to Dual Eligible prospects to assist them with the Medicaid Enrollment process from start to finish, as well as provide Medicare Enrollment guidance. This position is responsible for monitoring and optimizing processes related to MassHealth & Medicare eligibility and enrollment. Will work with existing Dual prospect referrals from the DSNP Sales Reps and external brokers, and conversions will go toward an individual, monthly target.

Essential Functions

• Analyze prospect eligibility related to the Medicaid & Medicare enrollment process.
• Keep up to date on Medicaid and Medicare requirements.
• The role will work with existing SCO & One Care prospects who have identified a desire to enroll with MGBHP.
• Deliver an exceptional prospect experience via both telephonic and written outreach.
• Assist prospects with the Medicaid & Medicare process by explaining eligibility requirements and applicable forms.
• Collaborate with internal team, specifically Duals Field and Inside Sales Reps, and external brokers to work on pipeline cases.
• Collaborate with external stakeholders if needed.
• Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve enrollment experience.
• 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 in the CRM system.

Qualifications

Education

High School Diploma or Equivalent required

Experience

• At least 2-3 years of experience in sales, healthcare, or insurance with a focus on Government Markets required
• At least 1-2 years of experience with MassHealth Eligibility and Application Process preferred
• Bilingual (Spanish/English) preferred

Knowledge, Skills, and Abilities

• Familiarity with relevant healthcare regulations, including the Health Insurance Portability and Accountability Act, to ensure compliance and maintain patient confidentiality.
• Familiarity with call center software, customer relationship management systems, and other relevant tools used in a call center environment.
• Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment.
• Familiarity with the healthcare industry, hospital operations, and medical terminology is important for effectively understanding and addressing customer inquiries.
• Familiarity with Dual Eligible products in Massachusetts.
• Ability to motivate and inspire staff to provide exceptional customer service while maintaining productivity and efficiency.
• Strong problem-solving skills to handle escalated or challenging customer interactions effectively.
• Dedication to providing exceptional customer service and ensuring a positive experience for patients, visitors, and other stakeholders.
• Ability to travel to meet with internal and external partners and prospects.

Additional Job Details (if applicable)

Working Conditions

Hybrid role with a combination of remote work, local travel, and quarterly in-person team meetings in Somerville, MA

Periodic local travel required to visit customer/client accounts. Candidates must be able to travel locally with reliable transportation

Remote workdays require a stable,