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Fallon Health Government Programs Eligibility Specialist in Worcester, Massachusetts


About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary of Purpose:

Responsible for working with Summit ElderCare pre-enrollees, participants, caregivers, staff and external regulatory staff (such as MassHealth) and NaviCare NHC pre-enrollees to assure that enrollment in the Medicare and Medicaid systems is accomplished accurately and efficiently with appropriate information entered in the Fallon Health systems. Also, responsible to ensure recertifications are submitted timely and ensure MassHealth has processed. Will interact with Fallon Health corporate staff as well as NaviCare and Summit ElderCare staff to produce defined reports. Acts as administrative support person to non adult day health center personnel as needed.


  • Obtains information necessary from enrollees/caregivers to process Medicare/Medicaid enrollments.

  • Coordinates application processes to assure required timeframes and desired outcomes are met.      

  • Communicates appropriate information to NC and SE staff in a timely manner.

  • Communicates information to appropriate FCHP departments.

  • Reviews information in QNXT, MMIS, Nextgen and CaseNet and other systems to assure accuracy.   

  • Interacts with Social Worker/GSSC’s/Navigators and other staff to assure that information is always up-to-date and accurate.

  • Prepares and submits appropriate long-term care change forms as needed.

  • Completes Medicare, Medicaid and private pay reconciliations in conjunction with FCHP staff.

  • Compiles Medicare/Medicaid enrollment data as needed for reports.

  • Implements disenrollment proceedures.

  • Answers marketing telephone line as assigned.

  • Provides administrative support as assigned such as telephone back-up, schedule management, ordering supplies, data entry and document preparation and management.    



High School graduate. Associate or Bachelor’s degree desirable. *     *


At least 2 years experience working in a geriatric or senior service setting. Knowledge of Medicare and Medicaid eligibility requirements highly desireable. Customer service and strong computer experience required.

Additional performance requirements : Excellent verbal and written communication skills. Ability to manage a process to completion with minimal supervision. Functional command of Microsoft Office software. Knowledge of IDX

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 2 months ago (10/15/2021 6:46 PM)

Job ID 6558

# Positions 1

Category Medicare Medicaid Programs