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Eligibility Specialist

Full Time
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Job Description

Responsible for all activity related to Medicaid Eligibility, including applications and redeterminations. Acts as liaison between TIC and MDHHS. Responsible for submitting participant status changes based on the Bamboo Health system.

Job Responsibilities

  • Complete and review all Medicaid related documentation, primarily Medicaid applications, and submit to MDHHS
  • Collaborate with the Initial Assessment (IA) teams to ensure all verifications required for the initial Medicaid application are received, and advise IA teams of new participant status upon review of financial documentation.
  • Create a client log sheet of new Medicaid applications and submit to the Adult Medical Services District weekly.
  • Act as TIC liaison with MDHHS on a daily basis with issues and concerns related to participant issues and Medicaid eligibility. Work closely with Data Analyst to send daily inquiry logs to MDHHS
  • Respond daily to email inquiries from MDHHS regarding Medicaid and Food Assistance application issues. Collaborate with Supports Coordinators (SC) to obtain required verifications and completed documentation.
  • Attend Medicaid Pending meetings to review current and on-going participant Medicaid issues. Consult with MDHHS regarding identified issues for clarification.
  • When needed, contact program participants and/or family members and schedule a home visit to pick up needed verification documentation and complete new Medicaid applications or redeterminations.
  • Update the master redetermination database of participants that are due each month.
  • Work closely with Care Management Department (CMD) on tasks related to programs and needs.
  • Receive input from CMD staff on issues related to MDHHS including new and pending Medicaid applications and department needs.
  • Provide training on Medicaid applications, food assistance applications and redeterminations to all new department staff.
  • Utilize Bamboo Health system to submit timely and accurate status changes for participants. Notify Supports Coordinators of participant care setting changes and program status changes.
  • Submit timely and accurate participant enrollment and disenrollment information to the Data Analyst to be entered in the CHAMPS system.
  • Complete other duties as assigned.

Required Knowledge & Skills

Knowledge of:

  • Knowledge of health and human services delivery and terminology.
  • Proficient in Microsoft Office products specifically Outlook, Excel, Word and PowerPoint.
  • Ability to learn new software; COMPASS, CHAMPS, Patient Ping, MI Health Plan Benefits is required.
  • Working knowledge of current HIPAA requirements as they relate to participant and program confidentiality.
  • Working knowledge of Medicaid Eligibility and Application process.

 

Skills and Ability to:

  • Display excellent oral and written communication skills.
  • Display strong organizational skills and attention to detail.
  • Display sound judgement and decision making skills.
  • Display strong critical thinking and analytical skills.
  • Ability to successfully manage several projects simultaneously.
  • Ability to work independently and in a team environment.
  • Ability to work in a team with the Care Management Department and Community Resources Department management and staff to identify and remediate issues related to Medicaid eligibility.
  • Display professional behavior and maintain appropriate boundaries.
  • Must have reliable transportation.
  • Must possess and maintain valid Michigan Driver’s License and vehicle insurance.

Education & Experience

Education:

  • Bachelors or Associates degree in Human Service field required.

Experience:

  • Two years’ experience or equivalent working in the Human Service or Health Care field.
  • MDHHS program application and eligibility experience preferred.

 

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