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Membership Retention Specialist

Company: Harbor Health Services
Location: Boston
Posted on: September 19, 2023

Job Description:

Harbor Health Services is an innovative, growing, mission-based organization that lives, serves and collaborates with our community members to achieve our mission to help individuals reach their full potential through access to local, affordable services that promote health. Harbor provides medical, behavioral health, dental, and support services to more than 34,000 patients in Boston, the South Shore, and Cape Cod. Harbor Health also operates two Programs for All-Inclusive Care for the Elderly in Mattapan and Brockton, providing comprehensive healthcare, transportation and social services for more than 450 frail elders who continue to live with dignity and independence in the community and a Woman, Infants and Children (WIC) Nutrition Program. To help further the mission of Harbor, we are looking for a talented Membership Retention Specialist to join our team at the Elder Service Plan.

Harbor Health offers an excellent, comprehensive benefits package including Health, Dental, Vision, Life, & Disability insurance, 403b Savings Plan, Generous Paid Time Off plus 11 additional Holidays and much more!


The Membership Retention Specialist is primarily responsible for ensuring that the annual MassHealth Redetermination Applications and MassHealth Long Term Care Conversion Applications are complete for all existing PACE Program Participants. The Membership Retention Specialist provides outstanding customer service to our participants while maximizing revenue and limiting non-payments and works directly with Participants, Care Givers/Financial Contacts, various departments in ESP and MassHealth, and third parties assisting with applications.


Responds to all participant and provider inquires in a courteous, responsive, comprehensive, effective, and accurate manner following all departmental and organizational policies and procedures consistently and with exceptional customer service.
Completes the annual Medicaid redetermination process & LTC conversion process.
Actively listens to customers, analyzes their concerns/requests and applies understanding of PACE policy and procedures to resolve the issues.
Effectively manages all MassHealth Notices in order to remain informed on MassHealth requests per Participant.
Manages all reports of LTC conversions accurately.
Works with Nursing Home Business offices to obtain required documentation for LTC applications.
Monitors the status of submitted applications until approval of coverage is obtained.
Responds to all requests for information (RFI) notices sent in connection to submitted applications.
Manages work for all assigned Participants.
Coordinates collection of required documents from various sources and ensures timely submission of documents to MassHealth.
Creates a caring atmosphere for customers.
Takes ownership of work and results.
Thoroughly documents all participant related interactions in the CRM database (Maximizer) for accurate tracking and analysis.
Accurately manages and updates CRM database as assigned.
Must be able to travel in a timely manner to meet with participants, caregivers, vendors, or others as needed in their homes or off-site offices in the ESP PACE service areas.


Bachelor's degree required or equivalent professional experience may be substituted
Experience working with Medicaid preferred
Two years of experience in a professional office setting preferred
Intermediate Microsoft Word and Excel required
Proven problem-solving skills and critical thinking required
Excellent communication skills and verbal, interpersonal and written customer service skills
Proven attention to detail
Ability to meet deadlines and organize workload
Bilingual preferred especially Cape Verdean, Hattian Creole, Spanish or Portuguese
Experience using a CRM preferred
Proven interest and ability to learn new software programs
Must be able to timely travel between all Harbor sites in a timely manner

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Keywords: Harbor Health Services, Boston , Membership Retention Specialist, Other , Boston, Massachusetts

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