Medicaid/Medicare Services Specialist II

Advertisement for a full-time position within the Kentucky Cabinet for Health & Family Services, Department for Medicaid Services. Hybrid telecommute may be authorized.

About the role

The Medicaid/Medicare Services Specialist II serves in the Kentucky Health Benefit Exchange Branch, which oversees Kentucky’s State-Based Marketplace, kynect. The branch ensures Kentuckians have access to affordable, high-quality health coverage and exceptional customer service through programs such as Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP).

Responsibilities

• Assist customers with applications, eligibility determinations, renewals, and changes in circumstance for health coverage programs administered through kynect.
• Review and evaluate eligibility information to ensure accurate and timely determinations in accordance with state and federal laws, regulations, and policies.
• Research complex eligibility and policy issues to identify appropriate resolutions and ensure compliance with established program requirements.
• Respond to customer, provider, stakeholder, and partner inquiries regarding eligibility, enrollment, and health benefit programs through multiple communication channels.
• Provide exceptional customer service while maintaining professionalism, confidentiality, and empathy when interacting with individuals experiencing difficult or stressful situations.
• Interpret and apply federal and federal regulations, policies, and procedures to make sound eligibility and program decisions.
• Document case actions, research findings, and customer interactions accurately and thoroughly within applicable eligibility and case management systems.
• Support implementation of new policies, procedures, and initiatives related to the Kentucky Health Benefit Exchange.

Requirements

• Bachelor’s degree from an accredited college or university.
• Two years of experience in one or more of the following areas:
  • Medicaid or Medicare program administration
  • Health insurance administration/systems
  • Eligibility systems
  • Health care research, planning, or financial management
  • Health care policy development
  • Human service or health care administration
  • Insurance billing and/or claims
  • Research, review, and analysis of legislation or regulations
• Experience in the above fields may substitute for the required college degree on a year-for-year basis.
• Current or prior military experience may substitute for the required college degree on a year-for-year basis.

Preferred Skills

• Knowledge of eligibility policies for Medicaid, Qualified Health Plans, and other health coverage programs.
• Ability to interpret and apply complex state and federal regulations.
• Strong analytical and problem-solving skills with attention to detail.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced environment while meeting established deadlines.
• Experience providing high-quality customer service to diverse populations.
• Ability to de-escalate difficult customer interactions and resolve issues professionally.
• Proficiency using multiple computer systems and databases simultaneously.
• Ability to establish and maintain effective working relationships with internal and external partners.
• Excellent computer skills, especially in Microsoft Office, with experience using Excel.
• Ability to work independently with attention to detail, thoroughness, and accuracy in completing tasks.
• Ability to apply state and federal regulations to work outcomes.

Pay

$43,210.08 – $64,816.08 annually.

Schedule

Full-time, 37.5 hours per week. Eligible for overtime pay. Initial and promotional probationary period of 6 months.

Working Conditions

Primarily office-based. Hybrid telecommute may be authorized and may be modified or terminated at any time.