4/10/2022 (8:00 PM EDT)
Medicaid/Medicare Services Specialist II
Pay Grade 14
EXECUTIVE BRANCH | FULL TIME, ELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK
Cabinet for Health & Family Services | Department for Medicaid Services
We encourage applicants from all counties to apply as this position is approved for telecommuting.
The agency may authorized the selected candidate to telecommute. The candidate may need to report to Franklin County as needed. The agency may terminate or modify the telecommuting arrangement at any time.
The Cabinet for Health and Family Services ( CHFS) is one of the largest agencies in state government, with nearly 8,000 full and part time employees focused on improving the lives and health of Kentuckians. The Kentucky Department for Medicaid Services provides assistance with medical care for people with limited income and resources. The Division of Policy and Operations is devoted to ensuring beneficiaries receive quality medical care while preventing fraud, abuse and misuse.
The Enrollment Processing Branch processes system updates to ensure Medicaid Members have access to needed services and provides direction and guidance to the call center staff servicing Members and Providers Services . The Branch researches complex situations and provides assistance to Medicaid Members and Providers and other Divisions as needed.
The Medicaid/Medicare Services Specialist II in the Division of Policy and Operations, Enrollment Processing Branch will have the opportunity to work with friendly collogues in a rewarding atmosphere. The Enrollment Processing Branch processes system updates to ensure Medicaid Members have access to needed services and provide direction and guidance to the call center staff servicing our Members and Providers Services. The Branch researches complex situations and provides assistance to Medicaid Members and Providers and other Divisions as needed.
Responsibilities and Job Duties may include but are not limited to:
- Processing advanced complex enrollment functions
- Processing enrollment incidents assigned via CRM and email
- Responds to complicated inquiries from recipients and providers of Medicaid services, coverage and other issues
- Formulate written and oral responses to issues related to enrollment and eligibility
- Provide support and guidance to call center staff
- Ensure enrollment and eligibility updates and changes are managed correctly
- Perform in-depth review, research and analysis of healthcare information
Preferred Skills And Abilities
- Experience using KYMMIS, CRM and Worker Portal
- Excellent computer skills, especially accurately entering information and attention to detail
- Excellent organization and communication skills
- Adaptable attitude
- Excellent customer service skills
- Excellent written and verbal communication skills
EDUCATION: Graduate of a college or university with a bachelor’s degree.
EXPERIENCE, TRAINING, OR SKILLS: Two years of experience in Medicaid or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development, human service or health care administration, insurance billing and/or claims, or research, review, and analysis of legislation or regulations.
Substitute EDUCATION for EXPERIENCE: NONE
Substitute EXPERIENCE for EDUCATION: Experience in the above fields will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year for year basis. Prior military experience will only substitute if the individual received an honorable discharge, discharge under honorable conditions, or a general discharge.
SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE
Incumbents working in this job title primarily perform duties in an office setting.
This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.
If you have questions about this advertisement, please contact Cindy Toll at Cindy.Toll@ky.gov or 502-564-6890.
An Equal Opportunity Employer M/F/D
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