Medicaid Eligibility & Enrollment Specialist

Jobtailor; Worcester (MA); On-site; USD 52,000 - 66,000; Full time

Job summary

Fallon Health in Worcester, MA seeks an experienced administrative professional to maintain phone-system availability across Commercial and Regulatory lines. The role ensures enrollment and billing data stay accurate and compliant with CMS/EOHHS standards.

You will prioritize tasks, build strong relationships with customers and vendors, and support system upgrades and SOP documentation. Strong communication and organizational skills are essential.

Qualifications

• High School diploma required; bachelor’s degree preferred.
• 4+ years in an office environment, healthcare/managed care preferred.
• Strong analytical and problem-solving skills.
• Proficiency with MS Excel, Word, and Access.
• Excellent written and verbal communication.
• Ability to adapt in a fast-paced environment.

Responsibilities

• Maintain active and consistent availability on the phone system for all lines of business.
• Meet internal/external deadlines and comply with CMS and EOHHS regulations.
• Prioritize daily and weekly work.
• Maintain professional relationships with customers/vendors and resolve discrepancies.
• Ensure enrollment and billing records are current and accurate.
• Maintain up-to-date primary care physician assignments in the core system.
• Represent Fallon Health professionally in in-person meetings about eligibility and premiums.
• Assist with core system upgrade testing.
• Create and maintain desk top procedures and SOPs.
• Participate in process improvement projects and team meetings.
• Perform other duties to meet department goals and respond to changing priorities.
• Process department returned mail and maintain productivity records for dashboards.

Skills

Analytical skills

Problem solving

Communication skills

MS Excel

Time management

Organizational skills

Education

High School Diploma

Bachelor’s degree preferred

Tools

MS Word

MS Access

Job description

Fallon Health in Worcester, MA seeks an experienced administrative professional to maintain phone-system availability across Commercial and Regulatory lines. The role ensures enrollment and billing data stay accurate and compliant with CMS/EOHHS standards.

You will prioritize tasks, build strong relationships with customers and vendors, and support system upgrades and SOP documentation. Strong communication and organizational skills are essential.