Medicaid Insurance Specialist - MassHealth
: Job Details :

Who We AreAt Entyre Care, we believe that everyone deserves to live a dignified and independent life at home. To that end, we support friends and families in providing home care for their beloved ones with professional training and fair compensation. Our mission is to ensure that no caregivers feel overwhelmed or unsupported. Learn more about us at Your role as Health Insurance Specialist (MassHealth and Medicaid)We are seeking a dedicated and knowledgeable Medicaid Health Insurance Specialist to join our team. The ideal candidate will possess a strong background in researching member insurance issues, counselling patients on insurance plans, and navigating the complexities of MassHealth LTSS services. This role is vital in ensuring that our patients receive the best possible insurance solutions tailored to their needs.Key Responsibilities:

Assess and determine Medicaid eligibility for clients, utilizing the knowledge of MassHealth LTSS services and the specific benefits associated with various forms of MassHealth.

Provide guidance and counsel to patients regarding insurance plans, discussing risks and benefits to help them make informed choices.

Engage with patients in their homes to assist with onboarding, ensuring a smooth transition into necessary services.

Demonstrate a strong understanding of ACO/MCA plans within the Massachusetts health insurance system to aid clients in navigating their options.

Participate in training programs to become a certified application counselor (CAC) with expenses covered by MassHealth.

Research member insurance issues, addressing concerns related to benefits and eligibility, and help clients understand their options.

Familiarize yourself with prior authorization processes related to LTSS and MassHealth services, including hospice services and personal care assistance (PCA).

Display ambition and innovation in developing patient solutions through insurance options, constantly seeking to improve processes.

Maintain a self-starter mentality by tracking key quantifiable metrics related to patient enrollment documents to enhance efficiency in the enrollment process.

Practice keen listening skills to effectively connect with patients during insurance navigation, ensuring their needs are understood and met.

Communicate effectively with internal staff regarding trends and issues related to insurance enrollment, fostering cooperative problem-solving.Minimum Requirements:

Minimum of 2 years of experience in Medicaid eligibility and enrollment.

Foundational knowledge in Adult Foster Care is strongly preferred.

Experience in the insurance industry is strongly preferred.

Proven experience with client interaction and willingness to travel to patients' homes.

Strong interpersonal skills with the ability to engage with diverse populations and build rapport.

Fluency in both English and Spanish is strongly preferred.

Familiarity with MassHealth LTSS services, including the benefits of various insurance plans.

Understanding of ACO/MCA plans within the Massachusetts health insurance system.

Willingness to undergo training to become a certified application counselor (CAC).

General knowledge of prior authorizations in LTSS and services covered under MassHealth.

Self-motivated and proactive approach to finding innovative solutions for patient needs.

Strong communication skills to convey information clearly and effectively to patients and internal teams. #J-18808-Ljbffr