The MLTC Enrollment Coordinator is responsible to track and maintain enrollment and disenrollments for program members. The incumbent conducts tracking of disenrollment and transfer requests for MLTC/MAP and works collaboratively with the Assessment Team, Enrollment and Membership (E & M), and Marketing to coordinate enrollment, disenrollment and transfers for members enrolling in MLTC/MAP and those who are disenrolling.
Job Description
- Collaborate with the internal and external teams to develop and maintain the MLTC/MAP disenrollment operational processes and procedures.
- Coordinate the MLTC/MAP enrollment and disenrollment workflow. Troubleshoot cases which require further investigation by Marketing or Maximus to complete the eligibility and enrollment process
- Provide feedback regarding eligibility or enrollment inquiries to Marketing.
- Conduct disenrollment calls to MLTC/MAP members to inquire about disenrollment reason in an attempt to retain members in the program prior to their term effective date based on the State's T file roster.
- Maintain the accuracy of the MLTC/MAP Disenrollment tracking database log and data.
- Maintain 95% or better of accurate data entry rate in the appropriate systems.
- Research and respond to MLTC/MAP transfer/disenrollment inquiries, determines the appropriate follow-up action, facilitates issue resolution, and gathers supportive documentation.
- Conduct telephonic outreach to program members, primary care physicians, and other members of the team regarding plan transfers and disenrollments. Coordinates enrollment/disenrollment/eligibility/transfer activities and processes.
- Proactively troubleshoot and takes initiative to ensure accuracy of outgoing/incoming eligibility information and provides solutions to issues with the data; determines extent and reason for discrepancies.
- Understand NYSDOH and MetroPlusHealth systems and processes to verify enrollment and eligibility.
- Execute special projects and other assignments as assigned by MLTC/MAP leadership.
- Develop and maintain internal and external relationships to support management of scope and expectations.
- Adhere to all HIPPA standards and confidentiality requirements.
- Identify issues having an impact on unit operations and communicate them to the management team.
- Identify problems and recommends resolutions to the management team.
- Assist members and applicants in making appointments with the New York Independent Assessor (NYIA) to complete a Community Health Assessments (CHA) and Clinical Appointment (CA) for their Request for Personal Care Services and or CDPAS.
- Add the members or applicants in UAS-NY, uploads completed UAS documents within 24 hours of request or notification, and prepare the cases for review and determination of service.
- Give feedback to vendors and report findings to the management team
- Monitor SA files provided by NYIA and follows up on the applicants or members.
- Maintain the list of members in UAS-NY by adding the enrollment or closing enrollments once members are discharged from the program.
- Perform all other duties assigned by supervisor or manager.
Minimum Requirements
- High School graduation or evidence of having satisfactorily passed a High School Equivalency Program
- Excellent data entry skills in a variety of databases.
- Ability to multitask.
- Analytical skills, as well as familiarity with spreadsheets and basic reporting.
- Experience with coordinating data entry in a professional, pleasant phone manner simultaneously.
- Computer literacy and excellent written and oral communication skills required.
- Ability to work in a fast-paced environment
Preferred Qualifications:
At least 2 years of managed care experience, ideally in a Medicaid managed care setting.
Understanding of medical terminology.
Knowledge of medical management functions, experience working in medical management.
Job Type: Full-time
Pay: $57,000.00 per year
Benefits:
- 401(k)
- 403(b)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
Experience:
- Microsoft Office: 1 year (Preferred)
- Customer service: 1 year (Preferred)
- Managed Long Term Care: 1 year (Required)
Ability to Commute:
- New York, NY 10004 (Required)
Work Location: Hybrid remote in New York, NY 10004