Medicare/Medicaid Eligibility Specialist | Centauri Health Solutions, Inc


Role Overview

The Medicare/Medicaid Eligibility Specialist works with health plan members to determine eligibility for Social Security disability benefits. The Medicare/Medicaid Eligibility Specialist advocates and assists low-income Medicare beneficiaries apply to and requalify for government assistance programs. The Medicare/Medicaid Eligibility Specialist builds trusting relationships with members provide critical application assistance.

Role Responsibilities

  • Conducts telephonic outreach activities for members who need to apply or recertify and are potentially eligible for various Medicaid programs including the Medicare Savings Programs
  • Collaborates with government offices to accurately complete the application and recertification process
  • Secures documentation for Medicaid/MSP renewal applications if needed for members
  • Attention to detail by adhering to state requirements and securing supporting documentation
  • Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation
  • Participates as required in operational development programs
  • Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicare programs and Medicaid Outreach Operations
  • Demonstrates behaviors, actions, and attitudes that reflect our vision, mission and values
  • Understand and agree to role-specific information security access and responsibilities
  • Ensure safety and confidentiality of data and systems by adhering to the organizations information security policies
  • Read, understand and agree to security policies and complete all annual security and compliance training

Role Requirements

  • Medicare/Medicaid program experience, and experience with screening for Medicaid eligibility a strong plus
  • Expertise and knowledge of Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS) and the Medicare Savings Program (MSP)
  • Strong working knowledge with Microsoft Office programs, and some experience with Excel.
  • Excellent oral communication skills; ability to communicate with elderly individuals and governmental personnel
  • 2-3 years related experience with direct consumer interaction
  • Outstanding customer service and communication skills
  • Strong organizational, analytical, critical thinking and customer service skills
  • Ability to analyze and interpret governmental program criteria
  • Ability to manage a fast-paced environment
  • Must be able to navigate through multiple databases/monitors with a minimum typing speed of 45 wpm
  • Telephone experience and ability to interact and decipher information via telephonic or correspondence inquires
  • Strong subject matter expertise of Medicaid programs regulations and industry standards
  • Case management experience or related experience / intermediate
  • A compassionate and empathetic nature with a strong desire to help and make a difference
  • Bachelor’s or Associate’s Degree a plus

Centauri Health Solutions is an equal opportunity employer.

Other Details

  • Pay Type Hourly


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