Medicaid Eligibility Navigator

Fallon Community Health Plan, Inc.; 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 process enrollments, verify eligibility, and manage premium billing with accuracy and timeliness. You will interact with multiple departments to ensure CMS and MASS Health compliance and adhere to service level agreements.

Responsibilities include data entry, reconciling receivables, and supporting with regulatory reporting. Strong communication, organizational, and analytical skills are essential in a fast-paced

Qualifications

• Education: High School diploma required; bachelor's degree preferred.
• Strong analytical and problem-solving skills.
• Aptitude towards mathematical fundamentals.
• Excellent organizational skills and time management.
• Effective written and verbal communication skills.

Responsibilities

• Obtain information from potential participants to process Medicaid enrollments.
• Coordinate application processes to meet timeframes and outcomes.
• Communicate information to Fallon Health staff in a timely manner.
• Review information in core systems for accuracy.
• Maintain data integrity in eligibility and premium tasks.

Skills

Analytical skills

Problem-solving

Organizational skills

Communication skills

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 process enrollments, verify eligibility, and manage premium billing with accuracy and timeliness. You will interact with multiple departments to ensure CMS and MASS Health compliance and adhere to service level agreements.

Responsibilities include data entry, reconciling receivables, and supporting with regulatory reporting. Strong communication, organizational, and analytical skills are essential in a fast-paced