Medicaid Eligibility Specialist
4 weeks ago
Job Responsibilities:
• Understand, and assure compliance to and adherence with, the Medicaid enrollment regulations, and related Maryland Health Choice program policies and procedures related to Maryland Medicaid HealthChoice and Maryland COMAR regulations of their loss eligibility.
• Notify members, in accordance with ABHMD Policies & Procedures (which reflect Maryland Medicaid HealthChoice and Maryland COMAR regulations) of their loss of eligibility
• Conducts comprehensive evaluation of Members using care management tools and information/data review.
• Coordinate with Primary Care Sites when working with members on loss of Maryland Medicaid eligibility.
• Develop a process for effectively identifying members with issues and communicating resolution of the issue.Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Consult on matters regarding company policies, procedures, and practices.
• Monitoring, Evaluation and Documentation of Care.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Qualifications:
- 3+ years healthcare experience
- 3+ years' experience working with Medicare/Medicaid
- 2+ years of working with Medicaid eligibility requirements, enrollment, renewal, and redetermination related regulations and process.
- Associate's degree or equivalent experience
About NTT DATA Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
ESSENTIAL FUNCTIONSAll duties and responsibilities are essential job functions and are subject to possible modification to reasonably accommodate individuals with disabilities. Other functions and accountabilities may be assigned from time to time. Regular attendance is an essential function of this position. To perform this job successfully, the employee will possess the skills, aptitudes, and abilities to perform each duty proficiently.TYPICAL PHYSICAL DEMANDSRequires sitting for long periods of time. Some bending, stretching or reaching required. Requires the physical dexterity to operate a keyboard, calculator, telephone, copier and other office equipment as
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