Senior Care Enrollee Services Rep

Company: Fallon Health
Location: Worcester
Posted on: May 25, 2023

Job Description:

Do you enjoy helping the elderly and their families? Fallon Health is hiring an Enrolle Service Representative to work Hybrid, Mostly from Home but coming into the Worcester office 1 day/week helping people telephonically enroll into our very popular NaviCare program. We provide training and equipment. Schedule is M - F 8 am to 5 pm.About NaviCare:Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare members health care by working with each member, the members family and health care providers to ensure the best possible outcomes.Brief Summary of Purpose:Enrollee Service Representative is responsible:

• To execute the following tasks in accordance with the Senior Care Option (SCO) contract requirements, CMS regulations, NCQA standards, departmental policies and procedures, and other applicable regulatory requirements:
  • processing of enrollment applications
  • handling of all enrollees inquires, including but not limited to Medicare and Medicaid benefit handling prospect inquires.
  • To serve as a liaison between enrollees and FCHP with their concerns regarding their Medicare/Medicaid benefits, denied claims, referrals, and membership.Job Responsibilities:
    • Provides coverage for the NaviCare enrollment ACD line and handles Enrollees inquiries in a timely manner
    • Serves as a subject matter expert in the NaviCare product and benefits.
    • Processes enrollment applications in accordance with regulatory requirements and departmental policies. Strict adherence to department turn-around time standards. Ensures the enrollment database is maintained on a daily basis.
    • Validates enrollment with the confirmation of receipt of the enrollment (834) transaction.
    • Handles enrollees inquires in a timely manner and Utilizes CMS approved scripts as appropriate
    • Assists enrollees with their inquires related to Medicare and Medicaid benefitsEducation:Bachelors degree or equivalent combination of education and experienceLicense/Certifications:
      • Annually, required to pass a product certification exam
      • Annually, required to take the AHIP certification (can obtain after hire)Experience:
        • 1 3 years of previous professional experience in a related position, preferable healthcare.
        • Ability to communicate and present information to various levels of personnel.
        • Working knowledge of computer programs and software.
        • Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic.About Fallon Health:Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nations top health plans for member experience and service and clinical quality.Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.Fallon Health Vaccination Requirements:To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as Remote require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Keywords: Administrative, Operations, Customer Service, Elderly, Government Programs, Hybrid, Work from Home, Remote, telephonic#AP23RequiredPreferredJob Industries

Keywords: Fallon Health, Worcester , Senior Care Enrollee Services Rep, Sales , Worcester, Massachusetts