MEDICAID ELIGIBILITY VERIFICATION SPECIALIST

City of New York
New York, NY
Category Administration
Job Description
The Department of Social Services (DSS) is seeking a Medicaid Eligibility Verification Specialist to review and analyze Medicaid Assistance case records and computer data to determine eligibility for State and Federal funding. The position involves reviewing Medicaid enrollees assigned multiple Client Identification Numbers, preparing reports, and verifying client demographics. The successful candidate will work in the Bureau of Case Integrity & Eligibility Verification, ensuring categorical eligible payments adhere to regulatory requirements.

Requirements

  • Review and analyze Medicaid Assistance case records and computer data
  • Identify retroactive obligations and determine effective date of adjustment for Federal and State reimbursements
  • Review of Medicaid enrollees assigned multiple Client Identification Numbers
  • Prepare reports and Turnaround Documents (TADS) for demographic changes
  • Verify client demographics and prepare reports for referrals to Investigation, Revenue and Enforcement Administration (IREA)
  • Assess impact on claims and claim adjustments of funding requirements
  • Perform quality assurance for Enterprise Data Warehouse (EDW) and Medicaid Data Warehouse (MDW) queries
  • Complete manual case lookups for Medicaid related press inquiries, FOIL requests, and DSS/DHS/HRA Senior staff requests
  • Perform case review analysis of Agency audit findings
  • Work on special projects involving other areas of the agency
  • Provide back-up documentation to substantiate claims and claim adjustments
  • Create case records using screenshots from various systems

Benefits

  • Paid Time Off
  • 401k Matching
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