Job Description

JOB SUMMARY: 

 

The primary goal of the Enrollment Representative is to conduct phone outreach to health plan members in order to establish eligibility for MassHealth disability benefits and for potential benefits through Social Security (SSI/SSDI).  Interviews members to understand the implications of medical, psychological, and substance abuse conditions on their ability to function and enrolls the member into a disability-based Medicaid program.  Acts as a liaison between the member and MassHealth to ensure application is processed with both speed and accuracy.  Assists in completion of appropriate applications when necessary and serves as an advocate for the member.  Other responsibilities include, and are not limited to:

 

ESSENTIAL FUNCTIONS & RESPONSIBILITES:

 

·        Screen members via telephone to determine eligibility in a high-volume, production-oriented, call-center  environment.

·        Review the member’s medical history to understand the implications and complexities of their medical  situation and how it affects daily activities to determine program eligibility.

·        Assist members with contacting MassHealth in obtaining potential disability benefits.

·        Document all interactions and telephone conversations appropriately which includes all attempts to complete a screening and application, assessments made, and attempts to move an application through to a decision.  

·        Responsible for strict adherence to all HIPAA regulations and protecting member’s personal health and demographic information.

·        Inform members of documentation required to process the application, approximate time frames, and potential benefit information.

·        Manage referral case load in accordance with company guidelines.

·        Demonstrate a receptive and sensitive demeanor through empathy and compassion.

·        Respond to various written and telephone inquiries regarding eligibility, approval and denial determinations, status updated, and continuation or closure of benefits.

·        Respond to customer service requests, both internally and externally, within required timeframes to meet customer expectations.

·        Support HFI initiatives for quality improvement, change, growth, and excellence in business practices.

·        Participate in Department and HFI Committees and Projects as assigned by the Operations Manager/Supervisor.

·        Other duties may be assigned.         

 

MINIMUM REQUIREMENTS:

 

·         Bachelor’s degree or an equivalent combination of education and experience. 

·         Bilingual (Spanish/Portuguese), preferred. 

·         Working knowledge and experience with Medicaid and/or with the Social Security entitlement programs (SSI/SSDI), preferred.

·         Strong emotional strength and maturity to deal effectively with a challenging and vulnerable population.

·         Ability to effectively communicate by phone with diverse and culturally different populations. 

·         Ability to meet deadlines while balancing competing demands and performance benchmarks.

·         Excellent interpersonal and communication skills. 

·         Superior organizational and time management skills.

·         Self-motivated, responsible, and accountable.

·         Identifies own learning needs and seeks appropriate assistance.

·         Excellent computer skills including Microsoft Office and web-based databases.

·         Ability to work well within a fast-paced, team-oriented environment. 

·         Ability to function independently; have flexibility and personal integrity. 

·         Work Schedule: Full-Time Hours (40 hrs./week) Monday - Friday 9:00 - 5:00 pm.

 

 

EEO STATEMENT:

 

We are committed to a policy of non-discrimination and equal employment opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, sex, age, disability, veteran’s status, sexual orientation and/or genetic information.

 

Application Instructions

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