Medicare/Medicaid Enrollee Support Specialist

Fallon Health; Worcester (MA); Vor Ort; USD 26.000 - 36.000; Vollzeit

Zusammenfassung

Fallon Health in Worcester, MA seeks an Enrollee Service Representative for NaviCare to handle Medicare/Medicaid inquiries and enrollment-related tasks. You will serve as a liaison between enrollees and Fallon Health, addressing concerns about benefits, denied claims, referrals, and membership with accuracy and empathy.

The role requires a bachelor’s degree and 1–3 years in a related healthcare setting, with strong communication, confidentiality, and problem-solving skills.

Qualifikationen

• Bachelor’s degree or equivalent combination of education and experience.
• 1–3 years of related healthcare experience.
• Ability to communicate and present information to various levels of personnel.
• Working knowledge of computer programs and software.
• Excellent interpersonal skills and diplomacy.

Aufgaben

• Provides coverage for the NaviCare enrollment ACD line and handles enrollees inquiries promptly.
• Onboard training to learn essential systems, policies, and procedures and use key resources to ensure accuracy.
• Serves as a subject matter expert in the NaviCare product and benefits.
• Demonstrates knowledge of enrollment and disenrollment processes and regulations and uses CMS scripts where appropriate.
• Assists enrollees with inquiries related to Medicare and Medicaid benefits.
• Supports outreach and enrollment teams as a resource.
• Handles enrollees’ billing issues and presents them to Clinical Directors or reviewers as needed.
• Assists contracted providers with pending claims issues.
• Maintains confidentiality of patient and proprietary information; manages competing priorities.

Kenntnisse

Interpersonal skills

Communication

Negotiation

Ausbildung

Bachelor’s degree or equivalent

Jobbeschreibung

Fallon Health in Worcester, MA seeks an Enrollee Service Representative for NaviCare to handle Medicare/Medicaid inquiries and enrollment-related tasks. You will serve as a liaison between enrollees and Fallon Health, addressing concerns about benefits, denied claims, referrals, and membership with accuracy and empathy.

The role requires a bachelor’s degree and 1–3 years in a related healthcare setting, with strong communication, confidentiality, and problem-solving skills.