Medicaid Eligibility Specialist
2 weeks ago
As a key member of VNS Health, the Medicaid Eligibility Specialist plays a vital role in supporting our members through the Medicaid application and recertification process. This position involves engaging with VNS Health Plans members to facilitate their Medicaid applications and ensure timely recertification. You will be responsible for entering and updating member demographic information in our Recertification Tracking Tool, while also identifying and addressing any complex recertification cases that may arise.
Compensation:
$26.23 Hourly
What We Offer:
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
- Comprehensive health insurance for you and your family, including Medical, Dental, Vision, Life, and Disability coverage
- Employer-matched retirement savings plans
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for eligible degrees
- Opportunities for professional development and career advancement
- Internal mobility, CEU credits, and advancement opportunities
Key Responsibilities:
- Evaluate patient referrals to determine Medicaid eligibility and process applications accordingly.
- Conduct follow-up communications with members to gather any additional information required.
- Ensure that all necessary documentation is accurately recorded in the Recertification Tracking Tool.
- Submit Medicaid applications to the appropriate Human Resources Administration (HRA) office.
- Assist members with inquiries regarding surplus payments and fee assessments in cases of financial hardship.
- Prepare and submit applications for SSI members who have lost coverage, including Stensen, Milestone, and PA applications.
- Compile and present escalated cases for management review and resolution.
- Generate weekly and monthly productivity reports for management oversight.
- Analyze recurring issues and take appropriate actions, including escalation to senior staff as needed.
- Distribute Medicaid Recertification packets to members in preparation for their recertification.
- Develop and send lists of members requiring disenrollment to the Member Eligibility Unit (MEU) due to non-recertification, expiration, non-compliance, or ineligibility.
- Maintain organized documentation by scanning and filing records into the document repository, retrieving files as requested.
- Monitor members throughout the recertification process to ensure timely resolution.
- Participate in special projects and perform additional duties as assigned.
Qualifications:
Education:
Associate's Degree in health, human services, or a related field, or equivalent work experience is required.
Work Experience:
A minimum of two years of experience in healthcare, insurance, or social services, specifically in processing bills and Medicaid applications, is required. Strong oral and written communication skills, as well as effective customer service abilities, are essential. Proficiency in Microsoft Word and Excel is required. Analytical skills, including data compilation and report creation, are preferred.
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