PACE Eligibility & Enrollment Navigator

Upham's Community Care; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

Upham's Community Care is seeking a PACE Enrollment Specialist to guide participants through MassHealth and Medicare eligibility, applications, renewals, and enrollment processes. You will act as a primary resource for participants, families, and caregivers, ensuring seamless navigation of payer sources within the PACE framework.

You will collaborate with the IDT, Insurance/Billing, CMS, MassHealth, and external partners to meet regulatory requirements, monitor statuses, and resolve coverage

Qualifications

• Familiarity with MassHealth applications, renewals, redeterminations and eligibility verification processes.
• Understanding of PACE enrollment requirements and MassHealth impact on enrollment.
• Confidentiality and handling of sensitive participant information.

Responsibilities

• Explain MassHealth and Medicare eligibility requirements to prospective and current participants, families and caregivers.
• Educate enrollees on how PACE integrates Medicare and Medicaid benefits into one model.
• Identify eligibility barriers and coordinate resolution with the team.

Skills

MassHealth eligibility navigation

Medicare enrollment knowledge

Documentation review

Communication skills

Bilingual (English/Spanish)

Tools

Electronic Health Records (EPIC/OCHIN)

MS Office (Word, Excel, Outlook)

Job description

Upham's Community Care is seeking a PACE Enrollment Specialist to guide participants through MassHealth and Medicare eligibility, applications, renewals, and enrollment processes. You will act as a primary resource for participants, families, and caregivers, ensuring seamless navigation of payer sources within the PACE framework.

You will collaborate with the IDT, Insurance/Billing, CMS, MassHealth, and external partners to meet regulatory requirements, monitor statuses, and resolve coverage