Medicare DSNP Redetermination Coordinator

Responsible for outreaching to members to assist them with the Medicaid Enrollment Redetermination process. This position is responsible for monitoring and optimizing processes related to Enrollment Redetermination.

• Monitor and analyze health plan eligibility related to the Medicaid Redetermination and deeming process.
• Deliver an exceptional member experience via both telephonic and written outreach. Assist members with the Medicaid Redetermination process for our DSNP plans by explaining eligibility requirements and applicable forms.
• Collaborate with internal departments, including but not limited to Sales, Customer Service, and Clinical, to ensure seamless coordination.
• Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve member satisfaction.
• Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with regulatory requirements (e.g., CMS, Medicaid, Medicare, state and federal laws).
• Monitor and document member outreaches.
• Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment.

• Bachelor's Degree (experience can be considered in lieu of degree)

• At least 2-3 years of experience in Medicaid redetermination required
• At least 2-3 years of experience in healthcare operations, health plan management, or a related field required
• At least 1-2 years of experience in the Health Insurance Industry preferred

• Excellent customer service and communication skills, both verbal and written.
• Proficient in Microsoft Office:
  Word and Excel.
• Previous experience in a member-facing environment.
• Ability to identify trends, monitor performance, and implement process improvements.
• In-depth knowledge of Medicare Advantage or DSNP health plan enrollment operations.
• Strong attention to detail.
• Skilled in problem-solving, with the ability to troubleshoot issues and develop actionable solutions.
• Excellent teamwork and relationship-building skills with the ability to collaborate effectively in a fast-paced and dynamic environment with individuals from varied backgrounds.
• Ability to manage multiple projects and tasks simultaneously while maintaining organizational priorities.

• This is a remote role that can be done from most US states but candidates familiar with Massachusetts EOHHS requirements is preferred
• This is a full-time position with a schedule of 8:30 AM to 5:00 PM EDT

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.