Medicare Savings Program Specialist - REMOTE

The Medicare Savings Program (MSP) is a federal program that allows states to pay all or part of monthly Medicare premiums and cost sharing for eligible Medicare beneficiaries. The MSP team within the Medicare Eligibility Enhancement Programs at ForHealth Consulting administers this program for the Massachusetts Medicaid program, MassHealth.

Under the general direction of the MSP Manager or designee, the MSP Specialist provides customer service to MassHealth members, providers, and other authorized representatives regarding the status of MSP benefits, resolves issues related to payment of Medicare premiums, and updates Medicare coverage information and premium payment status in state systems. The MSP Specialist will assist in the coordination and management of the daily operations of the program

Responsibilities

*Identify, evaluate, and coordinate Medicare Savings Program benefits for MassHealth members.
*Provide direct customer service to MassHealth members including, but not limited to, answering, researching, and resolving inquiries in relation to Medicare coverage, eligibility and premium payments.
*Manage daily and monthly MSP transactions between MassHealth and Medicare
*Provide resolutions for MSP members who are experiencing issues related to payment of their Medicare premiums.
*Investigate and resolve Medicare coverage, premium payment, and other exception cases.
*Respond to inquiries from MassHealth members, their authorized representatives, providers, EOHHS staff, and state and federal agencies to coordinate Medicare Savings Program benefits as it relates to the member's eligibility.
*Responsible for documenting and tracking all information associated with cases and reporting cost savings and caseload data.
*Make appropriate referrals to various EOHHS units and federal agencies such as the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS) to coordinate functions as required.
*Ensure compliance with state and federal rules and regulations.
*Interpret and communicate state and federal rules and regulations clearly and concisely.
*Correspond with internal and external stakeholders, including representatives of the SSA, CMS, the Railroad Retirement Board (RRB), and MassHealth Customer Service Center (CSC) and MassHealth Enrollment Centers (MECs) to provide information and resolve issues as needed.
*Provide direct customer service to MassHealth members including, but not limited to, answering, researching, and resolving inquiries in relation to Medicare coverage, eligibility and premium payments.
*Research payment transaction codes generated by SSA, CMS, and MMIS to accurately process premium payments.
*Assist in training opportunities for co-workers and new staff
*Utilize databases and/or systems to track program activities
*Represent the Medicare Savings Program Unit at member appeal hearings, as needed.
*Identify and participate in quality improvement initiatives and projects to improve overall service delivery.
*Conduct business in accordance with approved standards and processes, including all data security, privacy, and usage guidelines
*Work independently and as a member of a team.
*Perform other duties as assigned.

Qualifications

*Bachelor's Level Degree or equivalent in Health Care Administration, Social Work, Public Administration, Health and Human Services, Public Health or related field
*2 years of relevant professional experience
*Ability to multitask
*Excellent customer service skills
*Effective time management
*Ability to understand, apply and explain pertinent laws, rules, regulations, policies, and procedures.
*Strong attention to detail
*Demonstrated ability to handle confidential information and to exercise judgment and discretion
*Demonstrated ability to assess priorities and operate in a flexible manner

PREFERRED QUALIFICATIONS:

*Previous insurance or benefit coordination experience
*Previous professional experience in customer service or call center role
*Knowledge of federal and state agencies, preferably health and human services organizations
*Ability to utilize questioning and listening skills that support effective telephone communication
*Knowledge of policies, programs, and procedures of the Medicare and Medicaid programs.
*Experience with state and federal information systems such as eligibility and enrollment systems
*Previous experience communicating professionally and effectively with public sector personnel, businesses, legal representatives, or private citizens
*Bilingual skills