Massachusetts General Hospital
Medicare Advantage and DSNP Enrollment Analyst
Massachusetts General Hospital, Somerville, Massachusetts, us, 02145
Mass General Brigham is a not‑for‑profit organization that supports patient care, research, teaching, and community service. We believe that high‑performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of our mission.
Job Summary This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D‑SNP Enrollment.
Duties and Responsibilities
Monitor and analyze Medicare Advantage and D‑SNP Enrollment operations to ensure timeliness, accuracy, and compliance internally; collaborate with vendor partners to monitor and analyze enrollment reporting.
Review, track, and communicate key performance indicators (KPIs) related to compliance, timeliness, and accuracy.
Work closely with internal departments, including but not limited to Sales, Finance, Customer Service, Claims, IT, Product, Marketing, STARS leadership, and Digital Services to ensure seamless coordination and integration of enrollment operations.
Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member satisfaction.
Assist with the implementation and management of new health plan products or changes to existing plans.
Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
Provide audit support, both internal and external, and support the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts.
Create and update Enrollment and Premium Billing reports; identify trends, recommend actions, and elevate findings to leaders as appropriate.
Performs other duties as assigned.
Complies with all policies and standards.
Qualifications
Bachelor's Degree required; experience can be substituted for years of experience.
At least 2‑3 years of Health Insurance or Healthcare Industry experience required.
Medicare experience preferred.
Massachusetts Medicaid experience preferred.
Working Conditions
This is a remote role that can be performed from most U.S. states.
Remote Type Remote
Work Location 399 Revolution Drive
Scheduled Weekly Hours 40
Employee Type Regular
Work Shift Day (United States of America)
Pay Range $62,400.00 - $90,750.40 Annual
Compensation and Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications, and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth.
EEO Statement Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282‑7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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Job Summary This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D‑SNP Enrollment.
Duties and Responsibilities
Monitor and analyze Medicare Advantage and D‑SNP Enrollment operations to ensure timeliness, accuracy, and compliance internally; collaborate with vendor partners to monitor and analyze enrollment reporting.
Review, track, and communicate key performance indicators (KPIs) related to compliance, timeliness, and accuracy.
Work closely with internal departments, including but not limited to Sales, Finance, Customer Service, Claims, IT, Product, Marketing, STARS leadership, and Digital Services to ensure seamless coordination and integration of enrollment operations.
Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member satisfaction.
Assist with the implementation and management of new health plan products or changes to existing plans.
Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
Provide audit support, both internal and external, and support the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts.
Create and update Enrollment and Premium Billing reports; identify trends, recommend actions, and elevate findings to leaders as appropriate.
Performs other duties as assigned.
Complies with all policies and standards.
Qualifications
Bachelor's Degree required; experience can be substituted for years of experience.
At least 2‑3 years of Health Insurance or Healthcare Industry experience required.
Medicare experience preferred.
Massachusetts Medicaid experience preferred.
Working Conditions
This is a remote role that can be performed from most U.S. states.
Remote Type Remote
Work Location 399 Revolution Drive
Scheduled Weekly Hours 40
Employee Type Regular
Work Shift Day (United States of America)
Pay Range $62,400.00 - $90,750.40 Annual
Compensation and Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications, and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth.
EEO Statement Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282‑7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
#J-18808-Ljbffr