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The Redetermination Coordinator helps members who have lost Mass Health coverage get essential documents to EOHHS to regain Mass Health coverage. The Coordinator will also help with annual Mass Health 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.
Essential Functions
-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.

Qualifications:

Education

• Bachelor's Degree (experience can be consider in lieu of degree)

Experience

• 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
• At least 1-2 years of experience in the Health Insurance Industry preferred

Knowledge, Skills, and Abilities

• 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.
• In-depth knowledge of Medicare Advantage or DSNP health plan enrollment operations.
• 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.

Additional Job Details (if applicable)

Working Conditions

• This is a remote role that can be done from most US states but candidates familiar with Massachusetts EOHHS requirements is preferred
• This is a full-time position with a schedule of 8:30 AM to 5:00 PM EDT

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours:

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$25.50 - $36.49/Hourly

Grade

5

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.