Medicaid Redetermination Eligibility Specialist - Remote

Role Overview:

The Medicare/Medicaid Eligibility Specialist advocates and assists low-income and disabled Medicaid beneficiaries apply to and requalify for government assistance programs. The Medicare/Medicaid Eligibility Specialist builds trusting relationships with members and their families to provide critical application assistance. You will deliver exceptional customer service, offer member support, and address questions related to the programs our organization screens for.

Role Responsibilities:

• Conduct telephonic outreach to members requiring a Medicaid renewal completed through IB or OB campaign calling
• Capture personal/sensitive, financial information to accurately determine eligibility for various government programs.
• Promote company services and gain cooperation from the health plan members or the head of household.
• Utilizes internal computer system to accurately complete the screening for account eligibility and disposition the account in a timely manner. 
• Compile, record, and evaluate personal and financial data to verify completeness and accuracy.
• Interpret and explain information such as eligibility requirements and application details.
• Initiate procedures to refer customers/members to other agencies for assistance as appropriate.
• Collaborate with government agencies to accurately complete recertification process utilizing online state portal or agency provided paper renewal documents
• Strong attention to detail by adhering to state requirements and securing supporting documentation.
• Meet daily, weekly, and monthly production goals, includes quality standards by ensuring proper phone etiquette, adherence to scripts, state regulations, HIPAA compliance meet ongoing corporate compliance standards, and make accurate and descriptive documentation.
• Participate as required in operational development programs.
• Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicaid and SCHIP Enrollment programs.
• Demonstrates behaviors, actions, and attitudes that reflect our vision, mission, and values
• Prepares for and actively  participates in all attended meetings.
• Performs miscellaneous administrative tasks as required.

Role Requirements:

• Able to navigate Windows-based screening system effectively. 
• Demonstrate application of data entry and related computer skills. 
• Moderate knowledge of Microsoft Office products.
• Outstanding customer service and communication skills.
• Place and receive calls via computer interface. 
• Track/monitor/retrieve information on calls. 
• Ability to analyze and interpret government program criteria.
• Basic Mathematics proficiency.
• Basic knowledge of government programs and associated eligibility requirements  
• Familiar with commonly used concepts, practices, and procedures within government health care programs.
• 2-3 years related experience with direct consumer interaction.
• HS Diploma required
• Ability to navigate and function in a fast-paced environment.
• Basic time management concept.
• Fluency in Spanish (speaking, reading, and writing) a PLUS