GENERAL SUMMARY OF POSITION:
This is a benefited position that is funded through an Interagency Service Agreement (ISA) with the Executive Office of Health and Human Services (EOHHS) and the University of Massachusetts Medical School. Medicare Premium Assistance, also known as Medicare Buy-In, is a federal program that allows states to pay all or part of monthly Medicare premiums and cost sharing for eligible Medicare beneficiaries who meet income and asset guidelines. The Medicare Premium Assistance Unit within the Medicare Eligibility Enhancement Programs at the Center for Health Care Financing administers this program for the Massachusetts Medicaid program, MassHealth.
Under the general direction of the Senior Manager, the Medicare Premium Assistance Program Coordinator will assist in the coordination and management of the daily operations of the program and seek to maximize benefits available in private and public programs in order to preserve MassHealth as the payor of last resort.
Identify, evaluate, and coordinate Medicare Premium Assistance benefits for MassHealth members.
Interact with MassHealth members, providers, families, EOHHS staff, and state and federal agencies to coordinate Medicare Premium Assistance 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 and the Centers for Medicare and Medicaid Services to coordinate functions as required.
Provide trainings to health care providers and other stakeholders on coordination of benefits with Medicare Premium Assistance.
Evaluate and update data information to maintain member Medicare coverage and premium payment status within the state Medicaid Management Information System (MMIS).
Correspond with internal and external stakeholders, including representatives of the Social Security Administration (SSA), Center for Medicare and Medicaid Services (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.
Research payment transaction codes generated by SSA, CMS, and MMIS to accurately process member Medicare coverage and premium payments.
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.
Represent the Medicare Premium Assistance Unit at member appeal hearings, as needed.
Investigate and resolve Medicare coverage, premium payment, and demographic exception cases.
Maintain, enhance and quality control existing systematic reports to capture exceptions and identify discrepancies.
Prepare internal reports and provide routine updates on productivity levels and status of assigned work.
Participate with MMIS technical team members in research and testing of change orders and Data Change Requests (DCR) to be implemented in MMIS.
Conduct business in accordance with approved standards and processes, including all data security and usage guidelines
Perform other duties as assigned
Bachelor's degree in Health Care Administration, or related field, or equivalent experience
4 years relevant professional experience
Excellent oral and written communication skills.
Effective time management and customer service skills.
Ability to interpret state and federal laws and regulations
Strong attention to detail
Demonstrated ability to handle confidential information and to exercise judgment and discretion
Proficient in Microsoft Word, Excel, and Access.
Previous insurance or benefit coordination experience
Knowledge of rules and regulations of the Medicare and MassHealth programs
Previous experience communicating professionally and effectively with public sector personnel, businesses, legal representatives, or private citizens
University Of Massachusetts Medical School