Role OverviewThe Medicaid Eligibility Verification Specialist will review and analyze Medicaid Assistance case records and computer data to determine which cases qualify for a category that is eligible for State and Federal funding. The role involves identifying retroactive obligations, preparing reports, and adhering to tight claim deadlines. The Specialist will also perform quality assurance for Enterprise Data Warehouse (EDW) and Medicaid Data Warehouse (MDW) queries, and provide back-up documentation to substantiate claims and claim adjustments.
What You Will Do
The main day-to-day responsibilities of the Medicaid Eligibility Verification Specialist include reviewing Medicaid/Family Health Plus enrollees assigned more than one Client Identification Number (CIN), preparing Turnaround Documents (TADS) for demographic changes, and preparing reports to share with MAP. The Specialist will also review Invalid Social Security Number Validation files, verify clients' demographics, and prepare reports of referrals to Investigation, Revenue and Enforcement Administration (IREA) for client call-in and suspected fraud cases.
Why It Might Be a Fit
The ideal candidate will have a strong attention to detail, excellent analytical skills, and the ability to work in a fast-paced environment. The Specialist will be responsible for ensuring categorical eligible payments adhere to all appropriate regulatory requirements, and will need to stay up-to-date with current Federal, State, and Agency policy and procedures.
Requirements
- A baccalaureate degree from an accredited college
- Three years of satisfactory full-time progressively responsible clerical/administrative experience
- One year of administrative or supervisory experience
- Excellent analytical skills and attention to detail
Benefits
- Paid time off
- Retirement plan
- Health insurance
- Life insurance
- Disability insurance
- Paid holidays
- Vacation days
- Sick leave
- Flexible work schedule
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