Data Management Specialist
CCA - Boston, MA

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ORGANIZATIONAL DESCRIPTION:

Commonwealth Care Alliance is a nonprofit organization providing integrated health care and social support services to people with complex medical needs. We have openings for individuals who want to be part of a committed and collaborative interdisciplinary clinical operations team providing high quality service to individuals with complex medical needs.

POSITION SUMMARY:

The Data Management Specialist will perform a variety of duties to maintain and support data integrity for the CCA eligibility systems. Provide accurate, prompt, and courteous customer service to written and telephonic inquiries. The inquiries originate from various CCA and affiliated staff and involve a variety of issues including Medicaid and Medicare eligibility, general inquiries and required research. The Data Management Specialist will work with various CCA and affiliated staff to facilitate the completion of enrollment applications for the SCO and other CCA programs. The Data Management Specialist is responsible for the data entry of member information into the eligibility systems.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Data entry of all new enrollments into the CCA eligibility systems
• Update demographic and eligibility data as requested or as work flow requires
• Review enrollment data reports from CMS, MassHealth, and contractors to:
o Confirm enrollment actions
o Identify and respond to information requests from CMS, MassHealth and contractors
o Identify potential enrollment and data discrepancies
o Determine proper course of action to resolve discrepancies
• Coordinate the process for acquiring the required documentation for members that temporarily or permanently reside in Skilled Nursing Facilities
• Thoroughly document and track research and required follow up in applicable systems

• Submit eligibility data and files as needed to external agencies

• Offer recommendations and participate in process redesign sessions

• Other projects as assigned

REQUIREMENTS:

· High school diploma required; Associates degree preferred
· Strong community based service and supports and /or medical terminology skills
· Previous experience, community based services and supports, referral management, call center or physician practice preferred
· Strong interpersonal, verbal and written communication skills
· Ability to work well in a team model

Commonwealth Care Alliance - 11 months ago - save job - block
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