Overview

Contacts and assists VNS Health Plans members with Medicaid applications and recertification. Enters and updates member demographic information into the Recertification Tracking Tool. Identifies and investigates problematic recertification cases and presents for resolution. Works under general supervision.

Compensation Range:$20.98 - $26.23 Hourly

What We Provide

• Referral bonus opportunities     
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays   
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability    
• Employer-matched retirement saving funds   
• Personal and financial wellness programs    
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care   
• Generous tuition reimbursement for qualifying degrees   
• Opportunities for professional growth and career advancement    
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities  

What You Will Do

• Reviews patient referrals and determines eligibility for Medicaid. Processes Medicaid applications. Conducts follow up contact with members when additional information is needed. Ensures proper documentation is recorded in the Recertification Tracking Tool.
• Submits Medicaid applications to Human Resources Administration (HRA) office.
• Assists members with any inquiries in regards to surplus payments and fee assessments when member claims hardship.
• Submits Stensen, Milestone, and PA applications to HRA for SSI members who have lost coverage.
• Prepares problem/escalated cases for management to review and resolve.
• Prepares weekly and monthly productivity reports for Management to review.
• Analyzes and investigates recurring issues; takes appropriate action including escalation to Senior Medicaid Recertification Coordinator or Supervisor. .
• Sends out Medicaid Recert packets to members in preparation for their Medicaid recertification.
• Develops and sends lists of members that need to be disenrolled to the Member Eligibility Unit (MEU) (non recertified, expired, non-compliant, or ineligible members).
• Scans, files into document repository; retrieves files as requested.
• Monitors members in the recertification process to ensure resolution.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

• Associate's Degree in health, human services, other related discipline or equivalent work experience, required

Work Experience:

• Minimum two years experience in health care, insurance, or social services processing bills and Medicaid applications, required
• Effective oral, written, verbal communication and customer service skills, required
• Personal Computer skills including Microsoft Word and Excel, required
• Analytical skills, including compilation and analysis of data, report creation and recommendations based on findings, preferred