Medicaid Redetermination Specialist

Job Description

The CMD Redetermination Specialist is responsible for the oversight and compliance of MI Choice Medicaid Waiver files that support financial eligibility in the MI Choice Medicaid Waiver program.

Job Responsibilities

1. Contact MI Choice Waiver Participants/Medicaid beneficiaries to confirm correct contact information.
2. Provide updated information to the Michigan Department of Human Services (MDHHS) regarding any demographic changes with the participant.
3. Review benefits in the CHAMPS system to determine benefits including Food Stamp benefits.
4. Create redetermination file for incoming enrolled MI Choice Waiver participants.
5. Oversee files to determine and ensure participant documentation is current.
6. Review, coordinate, and prepare annual redetermination documentation for MDHHS representatives including but not limited to:
   1. Bank statements
   2. Insurance documents
   3. Trusts
   4. Social Security Administration (SSA)
7. Track and report redetermination cases monthly, quarterly, annually as part of MDHHS guidelines.
8. Archives redetermination paperwork when a participant’s case is closed.
9. Archives closed Medicaid charts within the fiscal year and prepares them for off-site storage.
10. Reports any cases of non-compliance to both MDHHS, and the Eligibility Specialist

Required Knowledge & Skills

• Ability to coordinate with other community agencies and business including insurance companies, SSA, etc.
• Ability to organize work and duties in order of priority.
• Ability to use critical thinking skills
• Ability to use the Electronic Health record (COMPASS).
• An intermediate knowledge base of the Microsoft Office Suite.

Education & Experience

• Bachelor’s degree preferred in Health and Human Services, Business or Business Management.
• Associate’s degree accepted with experience.

• Related experience in social service preferred
• Experience with Medicaid systems and working with Michigan Department of Health and Human Services (MDHHS)
• General office and clerical experience required

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