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

JOB DESCRIPTION Job Summary <p>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.</p>Essential Job Duties <p><br> • Conducts candidate pre-screening for eligibility, and assists prospects/members with eligibility and coverage. <br> • 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. <br> • 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. <br> • Assists members with the recertification package. <br> • Educates/verifies and gathers budget information, and documents accordingly for members who have surplus or pooled trust. <br> • Conducts home visits to assist in completion of documents as needed. <br> • Submits documentation to state agencies within specified time-frames - ensuring participant coverage. <br> • 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. <br> • Monitors recertification time frames for each active member and maintains records on coverage status and recertification. <br> • Documents all member contacts and completes documentation related to recertification in appropriate systems. <br> • Notifies member of upcoming loss of eligibility and assists in safe transition for disenrollment. <br> • Maintains the highest level of integrity, courtesy, and respect while interacting with prospects and active members, employees and business contacts.</p>Job Requirements <p><br> • 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. <br> • Experience in one or more of the following areas: health insurance, home care, acute or sub-acute care, or long-term care. <br> • Knowledge of current community health practices. <br> • Proficiency navigating the internet and multi-tasking within multiple software/electronic documentation systems simultaneously. <br> • Interpersonal and customer service skills. <br> • Decision-making skills. <br> • Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. <br> • Technical skills in e-faxing, electronic archiving or encryption. <br> • Effective verbal and written communication skills. <br> • Microsoft Office suite and applicable software programs proficiency. <br><br><br> To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.<br><br> Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>