Medicaid Service Coordinator

Position Summary

The Medicaid Coordinator (MC) is a resource and support to the Clinical and Operational staff to maximize reimbursement with Managed Care Organizations and other payers.   The MC will be responsible for serving as a liaison with patients, and the organization by providing stellar customer service. 

Essential Functions

• Verify and continuously monitor patient Medicaid eligibility to obtain access to services.
• Prepare and submit monthly Managed Care Enrollment/Roster Reports and weekly encounter reports.
• Assist patients with applying for Health Insurance coverage via the NYS Marketplace and HRA Provider Portal.
• Assists patients with Public Transportation Automated Reimbursement (PTAR) Inquiries.
• Monitor Medicaid re-certification timeframes for each active patient, and contact patient or primary caregiver in person, by phone or letter to arrange a meeting, two months prior to the Medicaid expiration date.
• Contributes to the teams’ efforts to treat every member with respect, courtesy, and fairness in a way that provides superior customer service.
• Assist with Managed Care, Medicaid and private pay billing issues to maximize revenues.
• Escalate Medicaid Managed Care and operational issues to Managed Care Relations Manager for resolution.
• Maintain the highest level of integrity, courtesy, and respect while interacting with members, employees and business contacts.
• Engage patients for primary care services.
• Performs other duties as assigned.
  
  

Required Qualifications

• Bachelor's degree
• 3 years of specific industry experience in Medicaid Managed Care or HMO
• Experience with patient health information (PHI) databases (i.e EPACES and eCW).
• Familiar with Medicaid Eligibility guidelines and processes (i.e Surplus).
• Familiar with claims processing, billing and credentialing.
• Computer literacy with knowledge of Microsoft Office applications.
• Strong attention to detail and ability to handle sensitive and confidential information.
• Excellent communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams.
• Critical thinker and problem solver with high emotional quotient.
• Proactive and independent with the ability to take initiative.
• Excellent time management skills with a proven ability to meet deadlines.
  
  

Additional Requirements

• Able to work outside the traditional hours of 9:00 am to 5:00 pm upon request.
• Able to successfully become a Certified NYS Marketplace Assistor.
  
  

Supervisory Responsibilities

This position has no supervisory requirements.