PACE Eligibility & Enrollment Specialist

Upham's Community Care; Boston (MA); Presencial; USD 60 000 - 80 000; Tempo integral

Resumo da oferta

Upham's Community Care is seeking a PACE Enrollment Specialist to support MassHealth and Medicare eligibility, applications, renewals, and ongoing enrollment for PACE participants. You will guide participants, families, and caregivers, reviewing documentation and coordinating with the IDT and external partners to ensure timely enrollment decisions.

The role requires strong knowledge of MassHealth/Medicare rules, attention to detail, and ability to manage multiple applications while maintaining

Qualificações

• Familiarity with MassHealth applications, renewals, redeterminations, and eligibility verification processes.
• Understanding of PACE enrollment requirements and how MassHealth affects participation.
• Proven ability to navigate Medicare and MassHealth benefits and document accuracy.

Responsabilidades

• Explain MassHealth and Medicare eligibility and PACE benefits to participants and families.
• Conduct preliminary eligibility reviews including income, assets, and payer status.
• Identify barriers and coordinate resolutions with the team.
• Draft and issue required notices for enrollment decisions per CMS and MassHealth rules.
• Maintain tracking and documentation for enrollment activities and deadlines.

Conhecimentos

MassHealth enrollment

Medicare eligibility

Documentation review

Interdisciplinary teamwork

HIPAA compliance

EHR familiarity

Microsoft Office

Customer service

Bilingual (EN/ES/Creole)

Ferramentas

PACE Care Online

EPIC

OCHIN

Descrição da oferta de emprego

Upham's Community Care is seeking a PACE Enrollment Specialist to support MassHealth and Medicare eligibility, applications, renewals, and ongoing enrollment for PACE participants. You will guide participants, families, and caregivers, reviewing documentation and coordinating with the IDT and external partners to ensure timely enrollment decisions.

The role requires strong knowledge of MassHealth/Medicare rules, attention to detail, and ability to manage multiple applications while maintaining