Medicaid Specialist
Description:
Job Description
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages—and across all five boroughs—beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you’re right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
Salary Range: $50,000.00-55,000.00
MAJOR FUNCTIONS:
As a Medicaid Specialist, within the Entitlements Department, she/he will maintain a working relationships with the Department of Social Services/Medicaid Office/Expedited and Marketplace to ensure Medicaid Managed Care guidelines and policies and procedures are followed.
SPECIFIC DUTIES & RESPONSIBILITIES:
Conduct a comprehensive review to determine eligibility for Medicaid and Managed Care for the 820 Programs
Daily Review of consumers’ insurance verification and Managed Care
Communicate with consumers regarding insurance coverage, restrictions, and dis-enrollment (Medicaid/Managed Care, and Medicare)
Process Medicaid applications and recertifications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace
Investigate Medicaid issues related to eligibility, deferrals, denials and recertifications
Identify consumers with Medical and Pharmacy restrictions to complete MAP forms to the removal of restrictions
Process restrictions through the Managed Care System (MCS)
Resolve problematic Medicaid Managed Care and Department of Social Services issues
Navigate eMedNY (Epaces) / STARS / AWARDS / Manage Care portal systems
Daily Data eEntry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab
Prepare weekly status of consumers’ Medicaid/Managed Care/Medicare/Private Insurance status
Review weekly consumers’ Medicaid Managed Care coverage and dropped coverage
Prepare biweekly Medicaid Manage Care Reports to reflect current coverage
Assist consumers with the selection of Managed Care and NY State Market Place
Performs related or similar duties assigned by Director
EDUCATIONAL AND PROFESSIONAL REQUIREMENTS:
Associates Degree in relevant concentration required.
Bachelor's Degree preferred.
Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking required.
Minimum 2 years of experience in Medicaid, managed care plans, application process, re-certifications and regulations required.
1 years worth of experience with Medicaid and Managed Care and in Human Service Field highly preferred.
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.