Specialist, Eligibility-Masshealth (Remote)-Must reside in MA

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

Provides support for eligibility activities including screening of candidates and identification of qualified, eligible prospects for both long-term care. Assists current members with coverage renewals - ensuring that program participants are enrolled in and maintain applicable benefits and entitlements, and facilitates outreach to prospects who may qualify coverage.

Requirements

At least 2 years of experience in health care - preferably eligibility, screening, application processing, review, and/or recertification, or equivalent combination of relevant education and experience.
Experience in one or more of the following areas: health insurance, home care, acute or sub-acute care, or long-term care.
Knowledge of current community health practices.
Proficiency navigating the internet and multi-tasking within multiple software/electronic documentation systems simultaneously.
Interpersonal and customer service skills.
Decision-making skills.
Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
Technical skills in e-faxing, electronic archiving or encryption.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Responsibilities

Conducts candidate pre-screening for eligibility, and assists prospects/members with eligibility and coverage.
Participates with the care team in continuous performance improvement activities, facilitates performance improvement problem-solving, and contributes to superior customer service team efforts - ensuring every member is treated with respect, courtesy and fairness.
Educates and provides assistance to members and/or families, and completion/submission of recertification applications for potential and active members via telephone and home visits.
Assists members with the recertification package.
Educates/verifies and gathers budget information, and documents accordingly for members who have surplus or pooled trust.
Conducts home visits to assist in completion of documents as needed.
Submits documentation to state agencies within specified time-frames - ensuring participant coverage.
Tracks eligibility status via the state agency system and hotline for all prospect and active members; assists internal teams with verification of Medicaid eligibility through the state agency enrollment system.
Monitors recertification time frames for each active member and maintains records on coverage status and recertification.
Documents all member contacts and completes documentation related to recertification in appropriate systems.
Notifies member of upcoming loss of eligibility and assists in safe transition for disenrollment.
Maintains the highest level of integrity, courtesy, and respect while interacting with prospects and active members, employees and business contacts.