Salem Hospital NSMC
Medicare Advantage and DSNP Enrollment Analyst
Salem Hospital NSMC, Somerville, Massachusetts, United States, 02143
Job Summary
This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D-SNP Enrollment. Duties and Responsibilities include: monitoring and analyzing Medicare Advantage and D-SNP Enrollment operations to ensure timeliness, accuracy and compliance internally; reviewing, tracking, and communicating key performance indicators (KPIs) related to compliance, timeliness, and accuracy; working closely with internal departments to ensure seamless coordination and integration of enrollment operations; identifying operational inefficiencies or process bottlenecks and recommending improvements to enhance workflows, reduce costs, and improve member satisfaction; assisting with the implementation and management of new health plan products or changes to existing plans; supporting the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements; providing audit support, both internal and external, and supporting the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts; creating and updating Enrollment and Premium Billing reports; identifying trends, recommending actions, and escalating to leaders as appropriate; and performing other duties as assigned. 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. Additional Job Details
Working Conditions: This is a remote role that can be done from most US 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. Grade: 6. 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.
This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D-SNP Enrollment. Duties and Responsibilities include: monitoring and analyzing Medicare Advantage and D-SNP Enrollment operations to ensure timeliness, accuracy and compliance internally; reviewing, tracking, and communicating key performance indicators (KPIs) related to compliance, timeliness, and accuracy; working closely with internal departments to ensure seamless coordination and integration of enrollment operations; identifying operational inefficiencies or process bottlenecks and recommending improvements to enhance workflows, reduce costs, and improve member satisfaction; assisting with the implementation and management of new health plan products or changes to existing plans; supporting the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements; providing audit support, both internal and external, and supporting the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts; creating and updating Enrollment and Premium Billing reports; identifying trends, recommending actions, and escalating to leaders as appropriate; and performing other duties as assigned. 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. Additional Job Details
Working Conditions: This is a remote role that can be done from most US 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. Grade: 6. 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.