Job Summary
Responsible for working directly within the state of Florida FLMMS portal. In charge of providing on the spot verification of Medicaid eligibility to prospective Dual Eligible Special Needs Plans (DSNP) to the Medicare sales agents, required to verify monthly Medicaid eligibility of the currently enrolled Dual Eligible Special Needs Plan (DSNP) members. Responsible for working alongside the Department of Families and Children (DCF) to obtain the annual Medicaid recertification dates and required documentation for currently enrolled DSNP members to ensure members continue enrollment and maintain their eligibility with the plan. Responsible for identifying members who are at risk or who have lost their Medicaid eligibility and work alongside DCF and the member to submit all required paperwork and try to get them re-certified for Medicaid. Responsible for obtaining necessary paperwork from the members and/or additional resources such as the Social Security Administration and DCF to reinstate member’s Medicaid Eligibility or prevent members from losing Medicaid eligibility. Assist with outreach calls to members as needed.
Essential Functions
- Determines Medicaid qualification status for prospective Dual Eligible Special Needs Plan (DNSP) members using the State Medicaid Portal FLMMS.
- Verifies Medicaid eligibility for currently enrolled DSNP members on a monthly basis.
- Performs on the spot verification of Medicaid eligibility for DSNP enrollment of prospective members.
- Obtains annual Medicaid Re-certification for currently enrolled DSNP members.
- Works with currently enrolled DSNP members who have lost their Medicaid eligibility during the deeming process to assist with re-certifying them for the DSNP.
- Submits paperwork to DCF and other entities as needed to maintain or regain eligibility. Evaluates and monitors the process until benefits are approved
- Effectively manage Medicaid caseload. Follows up with clients on a weekly basis.
- Work alongside DSNP team to obtain and provide necessary information as needed.
- Responsible for working with Social Security Administration to obtain proof of income and complete representative payee form
Required Work Experience
5+ years related work experience. Experience Details:
Required Management Experience
No supervisory/management experience required
Required Education
High school diploma or GED
Additional Required Qualifications
Bilingual English and Spanish Ability to maintain and multi-task with a significant caseload Knowledge of adult Medicaid Excellent problem-solving skills and resourceful Strong organizational skills and detail oriented Extraordinary interpersonal and creative skills Excellent writing and verbal communication skills Knowledge of Google platform, MS word The following certifications: Department of Children and Families Community Partner Certification ACCESS Certification Completion of the following training required for DCF Community Partners: Additional DCF Required Training for DCF Community Partners: ACCESS Civil Rights Training- Community Partners ACCESS Program Overview ACCESS Self-Service Portal Training Online Email Notification Customer Training Service Delivery for the Deaf and Hard-of-Hearing Limited English Proficiency Update Language Limitations and Customer Rights Security Awareness Training
Additional Preferred Qualifications
Prior experience working with the Department of Children and Families (DCF) Prior experience working with the state Medicaid portal FLMMS Prior experience/knowledge of Florida State Medicaid Prior experience working with the Agency for Health Care Administration (AHCA) Prior experience working for the Social Security Administration (SSA)
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.