MassHealth Enrollment Specialist

Entyre Inc • Arlington, VA

9d • Hybrid

About The Position

We are seeking to grow our MassHealth Enrollment team! The ideal candidate will be dedicated and knowledgeable with all things Medicaid and MassHealth, and will possess a strong background in researching member insurance issues, counselling patients on insurance plans, navigating the complexities of MassHealth LTSS services and have a solid understanding of SCO, PACE and MassHealth Waivers. This role is vital in ensuring that our patients receive the best possible insurance solutions tailored to their needs. We’d love to speak to candidates who have CAC certifications or SHINE accredited.

Requirements

• Minimum of 2 years of experience in MassHealth eligibility and enrollment
• Proven experience with client interaction and willingness to travel to patients' homes.
• Strong interpersonal skills with the ability to engage with diverse populations and build rapport.
• Familiarity with MassHealth LTSS services, including the benefits of various insurance plans.
• Understanding of ACO/MCA plans within the Massachusetts health insurance system.
• General knowledge of prior authorisations in LTSS and services covered under MassHealth.
• Self-motivated and proactive approach to finding innovative solutions for patient needs.
• Strong communication skills to convey information clearly and effectively to patients and internal teams.

Nice To Haves

• Foundational knowledge in Adult Foster Care and SCO is strongly preferred.
• CAC or SHINE certified
• Experience in the insurance industry is strongly preferred.

Responsibilities

• Assess and determine MassHealth eligibility for clients, utilizing the knowledge of MassHealth LTSS services and the specific benefits associated with various forms of MassHealth.
• Provide guidance and counsel to patients regarding insurance plans, discussing risks and benefits to help them make informed choices
• Experience with over 65 community and knowledge of SCO
• Engage with patients in their homes to assist with onboarding, ensuring a smooth transition into necessary services.
• Demonstrate a strong understanding of ACO/MCA plans within the Massachusetts health insurance system to aid clients in navigating their options.
• Research member insurance issues, addressing concerns related to benefits and eligibility, and help clients understand their options.
• Familiarize yourself with prior authorization processes related to LTSS and MassHealth services, including hospice services and personal care assistance (PCA).
• Display ambition and innovation in developing patient solutions through insurance options, constantly seeking to improve processes.
• Maintain a self-starter mentality by tracking key quantifiable metrics related to patient enrollment documents to enhance efficiency in the enrollment process.
• Practice keen listening skills to effectively connect with patients during insurance navigation, ensuring their needs are understood and met.
• Communicate effectively with internal staff regarding trends and issues related to insurance enrollment, fostering cooperative problem-solving.

Benefits

• 11 paid public holidays and 21 days of PTO, giving you plenty of time to relax, recharge, and share good times with your loved ones
• Approximately 5 days of paid sick leave to take care of yourself when needed
• We offer comprehensive insurance through Blue Cross Blue Shield, and dental, vision, and life insurance with Unum
• You will have access to resources like SoFi for financial wellness, SmartSpend for exclusive discounts, Ladder for health and fitness support, and Fetch for pet care perks
• You will be enrolled into our 401(k) pension plan
• As this role involves home visits to our patients and clients, we’ll provide you with a monthly flat-fee driving allowance
• This role is Monday-Friday, 9.00am - 5.00pm. We offer flexible working hours, too!

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed