Medicaid Eligibility & Enrollment Specialist

Fallon Health; Worcester (MA); On-site; USD 30,000 - 42,000; Full time

Job summary

Fallon Health in Worcester, MA is seeking a Medicaid Eligibility Specialist to maintain timely eligibility, enrollment and premium billing data across MassHealth, NaviCare, Summit ElderCare, and other programs. You will enter data into Fallon Health’s core systems with speed and precision.

You will collaborate with cross-functional teams, resolve discrepancies, and ensure CMS/EOHHS compliance in a fast-paced environment.

Qualifications

• Experience in an office environment, preferably health care.
• Strong analytical and problem solving abilities.
• Excellent organizational and time-management skills.
• Effective written and verbal communication.

Responsibilities

• Obtains information from participants to process Medicaid enrollments.
• Coordinates application processes to meet timeframes and outcomes.
• Communicates information to Fallon Health staff in a timely manner.
• Reviews information in core systems to assure accuracy.
• Interacts with staff to ensure information is up-to-date.
• Completes required reconciliations for Medicare, Medicaid and private pay.
• Compiles enrollment data for reports.

Skills

Analytical skills

Organizational skills

Communication

Problem solving

Education

High School Diploma

Bachelor's degree preferred

Tools

MS Excel

MS Word

MS Access

Job description

Fallon Health in Worcester, MA is seeking a Medicaid Eligibility Specialist to maintain timely eligibility, enrollment and premium billing data across MassHealth, NaviCare, Summit ElderCare, and other programs. You will enter data into Fallon Health’s core systems with speed and precision.

You will collaborate with cross-functional teams, resolve discrepancies, and ensure CMS/EOHHS compliance in a fast-paced environment.