JOB PURPOSE:

The Disenrollment & Retention Specialist is responsible for tracking disenrollments of PACE participants and conducting disenrollment quality surveys in accordance with applicable CMS, NYSDOH, and PACE guidelines. The Disenrollment & Retention Specialist will develop, analyze, and prepare reports for the department. This person is expected to maintain ethical conduct and will be responsible for the quality and satisfaction of prospective and current participants, caregivers, and referral sources.

JOB RESPONSIBILITIES:

• Perform functions related the disenrollment process, including but not limited to, assistance with Medicaid, Medicare and/or PACE eligibility.

• Monitor the disenrollment email and eFax inboxes to ensure all correspondence are acknowledged and reviewed/responded to in a timely manner.

• If disenrollment paperwork is incomplete, work directly with care delivery, and any other audiences to gather any missing information.

• Meet with CenterLight site leadership to discuss and resolve any outstanding issues and concerns.

• Review disenrollment submissions and forms for completion and accuracy and ensure appropriate follow-up.

• Collaborate with care delivery to develop and maintain the disenrollment operational processes and procedures according to applicable CMS, NYSDOH, and PACE regulations as well as CenterLight policies.

• Troubleshoot disenrollment cases that require further review in order to complete the disenrollment.

• Provide feedback regarding the disenrollment to care delivery.

• Maintain a tracking log of all disenrollment received from care delivery.

• Research and respond to all disenrollment initiation inquiry and determine the appropriate action to facilitate resolution and gathers the required supportive documentation.

• Develop and implement effective systems and processes to ensure all required paperwork is completed and signed in a timely manner.

• All interactions and completed disenrollment tasks are to be recorded in the data warehouse and monitored.

• Develop new workflows and improve current ones to ensure and improve quality, efficiency and effectivity of Intake, Enrollment and Eligibility processes and advise on operational efficiencies necessary to meet enrollment and business goals.

• Work with all levels of the CenterLight Healthcare team in assisting with the resolution of Medicaid-related/Medicare eligibility issues, pre-enrollment, and 3 months preceding enrollment, direct eligibility and disenrollment as needed.

• Work collaboratively with the Marketing department in developing necessary materials related to disenrollment and retention.  

• Participate in developing trainings, policies, and standard operation procedures.

• Work with the Business Development, Provider Relations, and Marketing Teams to identify referral trends that will lead to conversion/retention of qualified PACE candidates into the program.

• Collect and review completeness of all required documents for processing enrollment transactions and reconciliation of eligibility, enrollment, disenrollment files, upload and monitor in data warehouse.

• Conduct quality calls to Participants to inquire about the disenrollment paperwork received prior to the disenrollment date based on the term date received on the State roster.

• Adhere to all HIPAA standards and confidentiality requirements.

• Give feedback to vendors and provide a report on their disenrollment.

• Identify any issues that will have an impact on the disenrollment process and report to management team.

• Serve as staff Liaison between Entitlement Unit and NYMC as required.

• Maintain knowledge and compliance of all applicable CMS, DOH and PACE-specific guidelines especially marketing, enrollment and disenrollments, including organizational and departmental policies and procedures.

• Ensure compliance amongst staff and contracted entities, with state & federal laws regarding Medicaid, Medicare and PACE Eligibility and regulations.

• Meet enrollment and disenrollment goals set forth by management that are subject to change.

• Provide excellent customer services and communication with referral sources and departments. 

• Maintain knowledge and compliance of all applicable CMS, DOH and PACE-specific guidelines esp. marketing, enrollment and disenrollments, including organizational and departmental policies and procedures and be the subject matter expert (SME) in your area.

• Promote CenterLight Healthcare’s initiatives and projects.

• Participate with quality improvement projects.

• All other duties assigned.

Weekly Hours: 40

Schedule: 8:30AM – 5:30PM

QUALIFICATIONS: 
 

Education:

• Associate degree in healthcare administration or related field required.

• Bachelor’s degree preferred in healthcare administration or related field.

Experience:

• Two to three (2-3) years of experience with MLTC/MAP/PACE and healthcare preferred; primarily in intake/enrollment functions and administrative management responsibilities.

• Deep knowledge of community-based long term care services to dual eligible and frail adult population.

• Knowledge of Medicaid, Medicare, and PACE regulations.

• Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage, and services of various public programs.

• Significant experience managing participant/patient clinical information in a shared network/web-based environment. 

• Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while addressing routine and long-term objectives.

• Highly organized and flexible to meet submission deadlines.

Other:

• Positive attitude and outlook with the ability to multi-task in a constantly changing environment.

• Team-oriented with the ability to gain cooperation through relationship building and positive persuasion.

• Written and verbal fluency in a secondary language a plus.

Physical Requirements

Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:

• Standing – Duration of up to 6 hours a day.

• Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.

• Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.

• Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job.

• Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.

• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)

• Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.

• Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.

• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

 

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):

$61,000.00 - $71,000.00