Medicare DSNP Redetermination Coordinator

Mass General Brigham • Somerville, MA

19h • $26 - $36 • Remote

About The Position

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. The Redetermination Coordinator helps members who have lost MassHealth coverage get essential documents to EOHHS to regain MassHealth coverage. The Coordinator will also help with annual MassHealth renewals. This Coordinator will also help with DSNP enrollment. The idea candidates has experience with QNXT and EAM software. Job Summary Responsible for outreaching to members to assist them with the Medicaid Enrollment Redetermination process. This position is responsible for monitoring and optimizing processes related to Enrollment Redetermination.

Requirements

• Bachelor's Degree (experience can be consider in lieu of degree)
• At least 2-3 years of experience in Medicaid redetermination required
• At least 2-3 years of experience in healthcare operations, health plan management, or a related field required
• Excellent customer service and communication skills, both verbal and written.
• Proficient in Microsoft Office: Word and Excel.
• Previous experience in s member-facing environment.
• Ability to identify trends, monitor performance, and implement process improvements.
• Strong attention to detail.
• Skilled in problem-solving, with the ability to troubleshoot issues and develop actionable solutions.
• Excellent teamwork and relationship-building skills with the ability to collaborate effectively in a fast-paced and dynamic environment with individuals from varied backgrounds.
• Ability to manage multiple projects and tasks simultaneously while maintaining organizational priorities.

Nice To Haves

• At least 1-2 years of experience in the Health Insurance Industry preferred
• In-depth knowledge of Medicare Advantage or DSNP health plan enrollment operations.
• experience with QNXT and EAM software
• candidates familiar with Massachusetts EOHHS requirements is preferred

Responsibilities

• Monitor and analyze health plan eligibility related to the Medicaid Redetermination and deeming process.
• Deliver an exceptional member experience via both telephonic and written outreach. Assist members with the Medicaid Redetermination process for our DSNP plans by explaining eligibility requirements and applicable forms.
• Collaborate with internal departments, including but not limited to Sales, Customer Service, and Clinical, to ensure seamless coordination.
• Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve member satisfaction.
• Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with regulatory requirements (e.g., CMS, Medicaid, Medicare, state and federal laws).
• Monitor and document member outreaches.
• Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level