Entitlement Medicaid Specialist

About the role

Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office, Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and 820 programs.

Responsibilities

• Conduct daily comprehensive review of consumers’ interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay
• Case conference difficult cases with the Director for guidance and support to ensure funding for 819 and Part 820 programs are obtained in a timely fashion
• Conduct interviews on new admissions for HRA/DSS/Medicaid/SSI/SSD/Self-Pay
• Expedite consumers with the selection of Managed Care Organization, assist with the NY State Market Place at point of admissions and upon Medicaid Eligibility
• Daily Data Entry of Medicaid Managed Care coverage / Medicare / Private Insurance / MAT in AWARDS, E-Lab and LabCorp Portal
• Daily update the Entitlement 820 Reports with consumers’ coverage
• Navigate Epaces (eMedNY) / Inovalon / STARS / SAAMS / AWARDS / WTW / Manage Care System Portals for coverage
• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, Medicare, and Private Insurance)
• Process Medicaid applications and recertifications for consumers through the Department of Social Services, NY State Exchange/Marketplace
• Investigate Medicaid disparities related to county / deferral / eligibility / denial / dropped / recertification
• Identify and process consumers with Medical / Pharmacy / Out-Patient restrictions through the Managed Care Organization and Managed Care System (MCS)
• Resolve problematic Medicaid Managed Care issues for Part 820 coverage
• Complete and submit bi-weekly 820 Medicaid Managed Care Reports
• Complete weekly Medicaid Manage Care Reports for five residential programs to reflect consumers’ coverage for the Pharmacy, Medical department and LabCorp
• Other relevant duties as assigned

Requirements

• BA Degree preferred
• Experience with Medicaid Managed Care; Human Services Field
• Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment
• Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking
• Notary Public Stamp