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Medicaid Services Specialist

3 months ago

Dover, United States DelDOT Full time

Introduction

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit today

Summary Statement

This position assists Health/Human Service Case Manager II staff in determining financial and technical eligibility for all Medicaid State Plan programs and the Supplemental Nutrition Assistance Program (SNAP). This position assists with the maintenance of a high-volume caseload of Medicaid and Medicaid/SNAP cases. The incumbent will be responsible for completing initial eligibility determinations, annual redeterminations, processing interim changes, responding accurately and timely to case, eligibility, and service-related inquiries from applicants, recipients, and representatives of applicants and recipients, internal and external stakeholders, Medicaid providers, other DHSS agencies, and the public.

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here. Reviews Medicaid policies and procedures with service providers and explains billing procedures. Authorizes approval for reimbursements for new equipment based on review of previous approval for similar equipment, and in accordance with Medicaid guidelines. Conducts training to service providers and medical personnel regarding covered equipment, billing and coding procedures. Reviews claims submitted by service providers to ensure information is valid and in compliance with regulations. Confers with other administrative staff, medical consultants, and community representatives as necessary to resolve policy and payment issues. Initiates and develops guidelines/policies for various Medicaid services and recommends program changes. Participates with other administrative staff in conducting program analysis and responding to requests for information from providers, government officials and other agencies. Revises procedure and coding manuals for use by providers.

Job Requirements

JOB REQUIREMENTS for Medicaid Services Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

Six months experience in benefits claims processing such as health, dental, or life. Six Months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data. Six months experience in interpreting Medicaid laws, rules, regulations, standards, policies and procedures. Six months experience in narrative report writing. Knowledge of medical terminology.

Conditions of Hire

Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.