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

JOB DESCRIPTION Job Summary

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.

Essential Job Duties

• 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.

Job 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. 

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To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V