Medicaid Service Coordinator

Responsibilities*

• 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.
• 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.
• Keep up-to-date on Medicaid Managed Care and other program issues, as well as changes in Medicaid/Medicare/HMO laws, and share information with members as necessary.
• Contributes to the teams’ efforts to treat every member with respect courtesy, and fairness in a way that provides superior customer services.
• Assist with Managed Care, Medicare and private pay billing issues to maximize revenues.
• Escalate Medicaid Managed Care and operational issues to Managed Care Relations Manager for resolution.
• Assist with the accurate and timely credentialing and re-credentialing of new and existing providers with Managed Care Organizations.
• Maintain the highest level of integrity, courtesy, and respect while interacting with members, employees and business contacts.
• Engage patients for primary care services.
• Participate in Health Home meetings as necessary and required, to support START’s Health Home Initiative.
• Perform all other duties as assigned.

Qualifications:

• Bachelors 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.
• Familiar with Medicaid Redesign Team (MRT) initiatives (i.e. health homes, DSRIP).
• Computer-literacy with knowledge of Microsoft Office applications.
• Proficient in Microsoft Excel to sort, filter and enter data, and Access to manipulate data and create reports.
• Strong analytical and technical skills.
• Excellent communication, interpersonal and decision making skills.
• Aptitude for using a fast-paced proactive vs. reactive approach to manage competing priorities.
• Excellent time management and presentation skills.
• Professional demeanor.
• Ability to work independently and collaboratively.

Benefits

• Vacation, personal, and sick leave
• Medical, dental, vision plans
• Pension & retirement plan
• Short & long-term disability
• Life insurance
• AFLAC
• Pet Insurance

Student Loan Forgiveness Programs

• Public Service Loan Forgiveness
• National Health Service Corp Loan Repayment

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Physical Requirements*
These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the position which are reviewed on each individual case.

While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision.

Limitations and Disclaimer

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

START is an equal-opportunity employer. We value a diverse workforce and an inclusive culture. START encourages applications from all qualified individuals without regard to race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, marital status, citizenship, disability, and veteran status.

START undertakes affirmative action strategies in its recruitment and employment efforts to assure that persons with disabilities have full opportunities for employment in all positions.

We encourage applicants with disabilities who may need accommodations in the application process to contact: engagement at startny.org ~Correspondence sent to this email address that is not related to requests for accommodations will not be reviewed. Applicants should follow the instructions above regarding how to apply.