Medicaid Eligibility Specialist

Cuyahoga County Board of Developmental Disabilities (Cuyahoga DD) is seeking a Medicaid Eligibility Specialist to expedite the process of establishing Medicaid eligibility for individuals enrolling in Home and Community-Based Services (HCBS) waivers, and to assist with maintaining Medicaid eligibility through redetermination processes.

Responsibilities

• Maintain daily communication and consultation with the Specialized Medicaid Benefits Center (SMBC) staff, Community Medicaid Caseworkers, and Support Administrators regarding scheduled appointments, required verifications, and results of initial and renewal interviews for waiver applicants/enrollees.
• Respond to a high volume of phone calls and emails from Cuyahoga DD and SMBC staff, walk-ins from providers, payees, and individuals/guardians regarding Medicaid eligibility, interview appointments, Medicaid verification, and other concerns.
• Coordinate and collect applicable forms for initial Medicaid enrollment, SNAP benefits, and renewals from Cuyahoga DD staff, individuals/guardians, payees, and providers to submit to SMBC.
• Review applications and communicate with Cuyahoga DD staff regarding errors and required corrections for Medicaid enrollment.
• Act as Authorized Representative for Cuyahoga DD on behalf of individuals, including receiving and processing JFS and ODM notices, gathering verifications, maintaining logs, scanning documents into OnBase, and attending interviews and Medicaid hearings.
• Work closely with SMBC to resolve data discrepancies, PLOMS, billing, and level of care issues; expedite pending Medicaid eligibility for waiver applicants.
• Use read-only access to Medicaid Programs (e.g., AEFMI and MITS) to verify eligibility for individuals on Medicaid, Social Security, Medicare, and other active Medicaid benefits (e.g., HCBS, OHCW, RSS, SNAP, and Passport).
• Review documents and respond to general questions related to Social Security and Medicare benefits.
• Provide technical assistance to CMS staff, individuals, and authorized representatives regarding Medicaid documents and billing issues; analyze MITS information to diagnose and resolve billing issues.
• Maintain a high volume of data in Cuyahoga DD’s OnBase and Gatekeeper software packages pertaining to Medicaid enrollment; report and verify changes in demographic, employment wages, and county-to-county transfers to SMBC/CDJFS.
• Attend meetings with Cuyahoga DD staff, providers, payees, and individuals/guardians at Cuyahoga DD, SMBC, or CDJFS offices.
• Perform Medicaid Administrative Claiming (MAC) activities as required by Waiver rules, policies, and procedures; ensure position functions are 100% MAC billable in compliance with DODD and ODM requirements.

Requirements

• High school diploma required.
• Two years’ work experience with CRIS-E system, MITS, and Medicaid eligibility process preferred.
• Two years’ work experience with HCBS waiver programs is preferred.
• Two years’ successful work experience with programs for persons with developmental disabilities (DD) is desirable.
• Valid state of Ohio driver's license and continued maintenance of excellent driving record.

Benefits

• Over 40 paid days off a year, including holidays.
• Government pension through Ohio PERS.
• Major medical insurance.
• Free dental, vision, life, and temporary disability insurance.
• Professional development reimbursement each year.
• Membership dues reimbursement each year.
• Mileage reimbursement at the IRS rate.
• Flexible Spending Account.
• Tuition reimbursement.
• Annual pay increases.

Pay

The starting salary range for this position is $56,385.00 to $63,000.00. The actual starting salary will be determined based on the candidate’s knowledge, skills, education, and experience, while considering internal equity and budgetary constraints.

Schedule

This position is not 100% remote. It requires working three days in-office each week (with at least two of those days at the Green Road Services Center in Highland Hills, Ohio) and two days remotely from home.