Medicaid Eligibility Specialist

SUMMARY

The Medicaid Eligibility Specialist helps individuals and families understand and complete Medicaid applications by gathering necessary documentation, reviewing eligibility requirements, and guiding them through the application process to access healthcare coverage through the Medicaid program; responsibilities may include interviewing clients, verifying income and assets, and advocating for their needs to ensure accurate and timely application submissions.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Client intake and assessment: Conduct interviews with potential Medicaid applicants to gather personal information, medical history, income details, and assess eligibility based on state guidelines
• Application guidance: Explain the Medicaid application process, including required documentation, deadlines, and potential challenges
• Document review and verification: Collect and review supporting documents like paystubs, bank statements, and medical records to confirm eligibility criteria
• Form completion: Assist clients in accurately completing Medicaid application forms, ensuring all fields are filled out correctly
• Eligibility determination: Analyze client information to determine their potential eligibility for Medicaid benefits based on state regulations
• Advocacy and appeals support: Represent clients in situations where their application is denied, assisting with the appeals process by gathering additional documentation and presenting a compelling case
• Agency outreach: Promote awareness about Medicaid eligibility throughout agency and work with clinical staff within the agency to promote awareness and respond to inquiries
• Completes special assignments and performs other duties as assigned

QUALIFICATIONS

• Bachelor's degree in the field of social work
• Certified as a Behavioral Health Case Manager II (BHCM II)
• Strong understanding of Medicaid guidelines and eligibility criteria
• Knowledge of applicable state and federal laws, regulations, and requirements
• Ability to analyze and interpret data
• Ability to work independently and as part of a team
• Excellent communication and interpersonal skills: to effectively interact with clients from diverse backgrounds
• Attention to detail: to ensure accurate application completion and documentation
• Problem-solving abilities: to address complex situations and navigate potential barriers
• Basic computer literacy: to access and manage online application systems
• Proficient in Word and Excel
• Must complete all in-service and external training requirements
• Two - Five years’ experience working with Medicaid preferred

HOW WE TAKE CARE OF YOU!

• We pay a generous portion of your Health Insurance
• Low-cost Dental and Vision Insurance
• Retirement Plan with employer contributions equal to 5% of annual salary
• Student Loan Repayment options
• No cost Employee Assistance Plan
• 3 Weeks Paid Time-Off (increases annually between years 2-10)
• 9 Paid Holidays
• 1 Floating Holiday to use at your discretion.
• 4 Rest and Relaxation days
• 3 days of Education Leave
• 4 hours of Volunteer Leave
• Eligible for Pay Increases and Bonuses annually
• Employer Paid Long-Term Disability and Life Insurance
• Hybrid work options at some locations

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

Red Rock Behavioral Health Services does not discriminate based on race, color, national origin, religion, gender, gender identity, age, marital/familial status, sexual orientation, or disability