Medicaid Eligibility Specialist

The Medicaid Eligibility Specialist supports Fallon Health's mission by providing timely and accurate eligibility, enrollment, and premium billing information for MassHealth, NaviCare, Summit Elder Care, and other regulatory products. The role involves collaborating with internal departments and external partners to ensure accurate data entry, compliance with CMS and EOHHS regulations, and efficient processing of recertifications and long-term care conversions. The specialist maintains data integrity within core systems, resolves discrepancies, and supports process improvements while adhering to strict deadlines and quality standards.