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Senior Care Enrollment and Eligibility Lead

Company: Fallon Health
Location: Worcester
Posted on: March 27, 2020

Job Description:

RESPONSIBILITIES

* Oversees workload of assigned team

* Collaborates with the manager on the daily workload, current assignments of team members and required adjustments (of staff and assignments) to meet business needs.

* Ensures team has appropriate resources and highlights areas of need to manager for resolution.

* Reviews staff schedules (scheduled hours, time off, etc.) with manager to ensure adequate coverage is provided.

* Raises concerns to the manager regarding issues that may affect the work environment, team or individual performance. Participates in implementing solutions as appropriate.

* Serves as subject matter resource for the team

* Acts as a senior resource person/subject matter expert for team members in all areas of the work, including but not limited to: application of appropriate policy and procedures, etc.

* Assists the team in resolving routine operational issues as they arise. Serves as second level escalation with internal and external customers as necessary to resolve issues.

* Acts as a point of contact and resource for the team.

* Assists with complex issues that fall within existing policy and procedures. Escalates to manager when appropriate.

* Promotes use of established practices and procedures.

* Participates in training and developing team

* Participates in the orientation of new staff.

* Assists with training and mentoring staff on the application of policy and procedures, documentation requirements, best practices, escalation requirements, use of supporting systems/applications, time management skills, etc.

* Monitors work for efficiency, effectiveness and quality, including conducting audits as requested by the manager.

* Provides feedback to the manager on team members performance achievement of goals and deliverables and assessment of competencies.

* Assists the Department Managers with developing and implementing processes and/or procedural improvements or changes.

* Serves as individual contributor, providing the full spectrum of responsibilities outline for the Sr. ESR/Sr. Medicaid Coordinator including but not limited to:

* Assists with managing of ACD lines

* Assists with hiring and orientation of new staff

* Supervise daily activities within the unit which includes:

* monitoring of work volume for staff person,

* reassigning work assignments based on the needs

* Monitors enrollment process to ensure the quality standards are met

* Conducts Call Quality

* Reports and analyzes enrollment and call data

* Provides assistance to the rest of the team, including Medicaid Coordinators and ESRs, regarding job related tasks and acts as a go to person

* Provide assistance with ad-hoc projects assigned by the manager

QUALIFICATIONS

Education, Licenses, certification and experience requirements:



Education: Bachelor s Degree in business, health administration, public health, nursing or related health preferred or

License: None required

Certification: None Required

Experience: 3 to 5 years in a management role within a health care setting managing front line call staff. Must have knowledge of regulatory requirements for the health care/appeal industry, excellent written and oral communication skills, excellent organizational and analytical skills, customer service focused, problem-solving ability, and conflict resolution skills.



Competencies:

* Customer focus

* Commitment Through Action

* Contributes to Team Performance

* Focus Upon Quality

* Flexible and Adaptive

* Accountability

* Leadership

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester , Senior Care Enrollment and Eligibility Lead, Other , Worcester, Massachusetts

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