Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws
|To retain current CCA members, by preventing or rectifying the disenrollment of members due to loss of Mass Health eligibility.|
- Understand, and assure compliance to and adherence with, Medicare & Medicaid enrollment regulations, and related CCA policies and procedures.
- Notify members, in accordance with CCA policies and procedures of their loss of plan eligibility.
- Ensure copies of notices and documentation are filed in members’ electronic records.
- Cultivate and maintain collaborative relationships with primary care site partners and community based outreach/enrollment organizations to engage their assistance in working with members to maintain CCA enrollment and correct demographic information.
- Thoroughly log all member related interactions into CCA member database for purpose of accurate tracking and analysis.
- Complete productivity and status reports according to the established timeframes.
- Offer recommendations for improvements in CCA practices to enhance service delivery and member and primary care team satisfaction.
- Engage key stakeholders to aide in the retention of members in order for them to maintain CCA enrollment.
- Educate external and internal coworkers on the retention process.
- Ensure all retention activities are resolved in a timely manner.
- Assist and advise team members in complex case resolution.
- Develop processes for effectively identifying members with reconciliation and retention issues and communicate a resolution for the issues to the team and other individuals.
- Complete other duties as assigned.
- BA/BS Degree preferred; will consider Associates Degree with 5+ years of experience or High School education with equivalent relevant experience.
- Experience working with Medicare & Medicaid eligibility requirements and enrollment related regulations and process.
- Experience in customer service, specifically working with elders and disabled individuals.
- Experience working with healthcare systems/services and/or experience working with community organizations, social services and public resources.
- Fluent Spanish oral communication skills preferred.