Entitlement Medicaid Specialist

MAJOR FUNCTIONS

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.

SPECIFIC DUTIES & 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

• Process applications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace

• Navigate eMedNY (Epaces) / STARS / AWARDS / Manage Care portal systems

• Daily Data Entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab

• Assist consumers with the selection of a Managed Care and NY State Market Place

• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare)

• Process restrictions through the Managed Care System (MCS)

• Prepare daily status of consumers’ Medicaid/Managed Care/Medicare/Private Insurance status

• Review weekly consumers’ Medicaid Managed Care coverage and dropped coverage

• Prepare biweekly Medicaid Manage Care Reports to reflect current coverage

• Performs related or similar duties assigned by Director

REQUIREMENTS:

• High School / associate degree

• Experience with Medicaid and Managed Care and in Human Service Field

• Background with HRA/DSS/SSI/SSD benefits, Recertifications, Medicaid, managed care plans,

• Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking skills