Benefits Consultant II
3 weeks ago
Duration: 03 Months
Job Summary:
looking for a Medicaid Eligibility Retention Specialist to work with and assist members to retain or renew their Medicaid eligibility and remain a member in the ABHMD Managed Care Organization (MCO) Plan, by preventing or rectifying the disenrollment of members due to loss of their Maryland Medicaid eligibility.
Responsibilities:
- Understand, and assure compliance to and adherence with, the Medicaid enrollment regulations, and related Maryland HealthChoice program policies and procedures related to Maryland HealthChoice member eligibility redetermination and renewals polices.
- Notify members, in accordance with ABHMD Policies & Procedures (which reflect Maryland Medicaid HealthChoice and Maryland COMAR regulations) of their loss of eligibility.
- Ensure copies of notices and documentation are filed in Members’ electronic records.
- Cultivate and maintain collaborative relationships - with primary care site partners, FQHC and community based outreach/enrollment organizations - to engage their assistance in working with members to maintain their Maryland Medicaid eligibility and correct information.
- Coordinate with Primary Care Sites when working with members on loss of Maryland Medicaid eligibility.
- Thoroughly log all member related interactions into Salesforce for the purpose of accurate tracking and analysis.
- Develop a process for effectively identifying members with issues and communicating resolution of the issue.
- Complete a Weekly Status Report for Supervisor and Managers.
- Offer recommendations for improvements in practices to enhance service delivery and member satisfaction.
- Participate in sponsored meetings and events.
- Represent in the community, when requested & provide other duties as assigned.
Experience:
- Associate's Degree or equivalent experience.
- Minimum Years’ Experience Required 3-5 years
- BA/BS Degree preferred.
- 3+ years of healthcare experience
- 2+ years’ experience specifically with Medicaid/Medicare program operations
- 1+ years’ experience with Medicaid policy, financing, program operations, business requirement development, or systems
- Experience working with Medicaid eligibility requirements, as well as enrollment, renewal and redetermination related regulations and process.
- Experience in customer service, specifically working with low-income and culturally diverse populations or, Medicaid enrolled or eligible individuals in person and on the phone.
- Experience working with healthcare systems/services and/or experience working with community organizations, social services and public resources.
- Experience working with Medicaid eligibility requirements, as well as enrollment, renewal and redetermination related regulations and process.
- Experience in customer service, specifically working with low-income and culturally diverse populations or, Medicaid enrolled or eligible individuals in person and on the phone.
- Experience working with healthcare systems/services and/or experience working with community organizations, social services and public resources.
Education:
- Associate's Degree or equivalent experience.
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