Fallon Health

  • Enrollee & Eligibility Specialist – Growing Program

    Location US-MA-Worcester
    Posted Date 1 week ago(6/7/2018 3:20 PM)
    Job ID
    # Positions
    Medicare Medicaid Programs
  • Overview

    About Fallon Community Health Plan:

    Founded in 1977, Fallon Community Health Plan is a nationally recognized, not-for-profit health care services organization. From traditional health insurance products available throughout Massachusetts for all populations, to innovative health care programs and services for independent seniors, FCHP supports the diverse and changing needs of all those it serves. FCHP has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fchp.org. 


    Brief Summary of Purpose:

    Responsible for working with Summit ElderCare pre-enrollees, participants, caregivers, staff and external regulatory staff (such as Mass Health) and NaviCare NHC pre-enrollees to assure that enrollment in the Medicare and Medicaid systems is accomplished accurately and efficiently with appropriate information entered in the FCHP systems. Also, responsible to ensure recertifications are submitted timely and ensure MassHealth has processed.  Will interact with FCHP corporate staff as well as NC and SE staff to produce defined reports.  Acts as administrative support person to non adult day health center personnel as needed. 


    • Obtains information necessary from enrollees/caregivers to process Medicare/Medicaid enrollments.
    • Coordinates application processes to assure required timeframes and desired outcomes are met.      
    • Communicates appropriate information to NC and SE staff in a timely manner.
    • Communicates information to appropriate FCHP departments.
    • Reviews information in QNXT, MMIS, Nextgen and CaseNet and other systems to assure accuracy.   
    • Interacts with Social Worker/GSSC’s/Navigators and other staff to assure that information is always up-to-date and accurate.
    • Prepares and submits appropriate long-term care change forms as needed.
    • Completes Medicare, Medicaid and private pay reconciliations in conjunction with FCHP staff.
    • Compiles Medicare/Medicaid enrollment data as needed for reports.
    • Implements disenrollment procedures.
    • Answers marketing telephone line as assigned.
    • Provides administrative support as assigned such as telephone back-up, schedule management, ordering supplies, data entry and document preparation and management.  
    • Some (limited) traveling required   


    Education:  High School graduate.  Associate or Bachelor’s degree desirable.     


    Experience:  At least 2 years experience working in a geriatric or senior service setting.  Knowledge of Medicare and Medicaid eligibility requirements highly desirable.   Customer service and strong computer experience required.




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