Medicaid Eligibility Specialist II (Las Vegas, NV / Hybrid)

About the role

We are seeking a Medicaid Eligibility Specialist II for our Nevada team. This role is a hybrid position requiring 3 days per week in Las Vegas, NV and 2 days remote.

Responsibilities

• Develop in-depth understanding of Nevada Medicaid’s programs including benefits, eligibility requirements, and enrollment process.
• Identify online resources and attend relevant Medicaid meetings to enhance patient experience.
• Verify patient eligibility for Medicaid benefits using various online systems and tools.
• Avoid incomplete or inaccurate documentation during the application process for Medicaid.
• Confirm coverage details and determine patient benefits based on Medicaid guidelines.
• Investigate Medicaid issues related to eligibility, deferrals, denials, and re-certifications through contact with the Patient or Patient representative.
• Maintain accurate and detailed records of verification processes and outcomes.
• Update patient records in Salesforce to reflect current Medicaid status.
• Serve as the point of contact for Medicaid inquiries from clients, caregivers, and Health plan partners.
• Assist clients in understanding Medicaid eligibility, benefits, and application processes.
• Advocate for clients to ensure they receive appropriate Medicaid services.
• Respond to inquiries from patients and healthcare providers regarding Medicaid coverage and eligibility.
• Collaborate with partnering departments to resolve any issues related to Medicaid coverage and recertification.
• Aid in training staff members on Medicaid verification procedures and policies.
• Collaborate with partnering departments, case managers, and other healthcare professionals to support patients' access to Medicaid benefits.

Requirements

• Associate degree or higher in healthcare administration, business, or a related field preferred.
• Minimum of 2 years of experience in healthcare, insurance verification, or a related field.
• Experience with Medicaid verification and understanding of Medicaid regulations is highly preferred.
• Bilingual Spanish/English required.
• Proven track record of strong customer focus and adaptability in a high call volume environment (inbound and outbound).
• A passion for providing a high level of customer service, including the ability to show empathy, active listening, and patience.
• Effective written and verbal communication skills with the ability to engage with diverse audiences.
• Technical proficiency with the ability to navigate through multiple systems; while maintaining attention to detail and data accuracy.
• Demonstrates fluency over all tools and resources specific to the role, with heavy reliance on Excel.
• The ability to embrace change and departmental growth in an evergreen environment.

Qualifications

• Must have a valid driver's license and reliable transportation.
• Must be able to pass a background check and drug screening.

Skills

• Attention to detail.
• Excellent communication skills.
• Strong organizational skills.
• Ability to multitask and manage time effectively.
• Knowledge of Medicaid policies, regulations, and procedures.

Benefits

At FreedomCare, we offer a comprehensive benefits package including medical, dental, and vision insurance, life insurance, short-term and long-term disability insurance, a 401(k) with company match, continuing education and professional development opportunities, opportunities for career growth, wellness programs, gym reimbursement, internet reimbursement, and competitive compensation. Technology and tools designed to support communication, documentation, and care coordination are also provided.