• Enrollment Retention Specialist, Hybrid

    Commonwealth Care Alliance (Boston, MA)


    011120 CCA-Enrollment

    Position Summary:

    Retain current members, who wish to remain current members in all of CCA’s Products, by preventing or rectifying the disenrollment of members due to loss of Mass Health eligibility.

    Supervision Exercised:

    + None

    Essential Duties & Responsibilities:

    + Understand, and assure compliance to and adherence with, Medicare & Medicaid enrollment regulations, and related CCA policies and procedures.

    + Notify members, in accordance with CCA Policies & Procedures (which reflect Medicare and MassHealth regulations) of their loss of eligibility.

    + Ensure copies of notices and documentation are filed in Members’ paper and electronic records.

    + Cultivate and maintain collaborative relationships - with primary care site partners and community based outreach/enrollment organizations - to engage their assistance in working with members to maintain CCA enrollment and correct information..

    + Coordinate with Primary Care Sites when working with members on loss of MassHealth.

    + Thoroughly log all member related interactions into CCA member database for purpose of accurate tracking and analysis.

    + Develop a process for effectively identifying members with issues and communicating resolution of the issue.

    + Complete a Monthly Status Report for Supervisor and CCA Managers.

    + Offer recommendations for improvements in CCA practices to enhance service delivery and member and primary care team satisfaction.

    + Help CCA with translation of member materials and interpretation as needed.

    + Participate in CCA sponsored meetings and events.

    + Represent CCA in the community, when requested.

    + Training and coaching of colleagues in the CCA SCO program, when collaborating to retain members.

    + Provide other duties as assigned.

    Working Conditions:

    + Standard Office Conditions

    + This position is 90% in office for telephone contact with members and other stakeholders.

    Required Education:

    + Associates Degree with 5+ years of experience

    + High School education with equivalent relevant experience.

    Desired Education:

    + BA/BS Degree

    Required Experience:

    + 3-5 years

    Required Knowledge, Skills & Abilities:

    + Experience working with Medicare & Medicaid eligibility requirements and enrollment related regulations and process.

    + Experience in customer service, specifically working with elders and disabled individuals in person and on the phone.

    + Experience working with healthcare systems/services and/or experience working with community organizations, social services and public resources.

    + Experience working with low-income, culturally diverse, population.

    Language(s):

    + English

    + Fluent Spanish oral communication skills a plus.

     

    EEO is The Law

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

    Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.