Membership Retention Specialist
Company: Harbor Health Services
Location: Boston
Posted on: September 19, 2023
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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!
Role:
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.
Responsibilities:
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.
Requirements:
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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