Entitlement Medicaid Specialist

Odyssey House Inc; New York (NY); On-site; USD 36,000 - 44,000; Part time

Benefits offered by this job

Medical Insurance (Two Plans)

Dental and Vision Insurance

Life Insurance

403(b) Plan

Educational Assistance Programs

Vacation Plan and Holidays

Flexible Spending Account/Health Reimb

Job summary

Odyssey House Inc. in New York is seeking an Entitlement Medicaid Specialist (Part-Time) to support funding for Medicaid programs through DSS, HRA, SSA, and the Medicaid Office. The role emphasizes eligibility reviews, care options, and coordination with State systems.

The position involves daily data entry in AWARDS and E-Lab, assisting consumers with Managed Care and NY Market Place selections, and clear communication on coverage changes and disenrollment.

Qualifications

• Experience with Medicaid and Managed Care in human services.
• Background with HRA/DSS/SSI/SSD benefits and recertifications.
• Proficiency with Excel, computer skills, organization and multitasking.

Responsibilities

• Maintain working relationships with DSS, HRA, SSA, Medicaid Office to ensure funding for 819 and 820 programs.
• Review interviews to determine eligibility for Entitlements benefits, Medicaid, Managed Care, Medicare and private insurance.
• Process applications through Local DSS or NY State Exchange/Marketplace.
• Daily data entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab.
• Assist consumers with selection of Managed Care and NY State Market Place.
• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment.
• Process restrictions through the Managed Care System (MCS).
• Prepare daily status of consumers’ coverage status and weekly/monthly reports.
• Perform related duties as assigned by Director.

Skills

Medicaid experience

Managed Care

Communication skills

Excel proficiency

Organizational skills

Multitasking

Tools

AWARDS

E-Lab

Job description

TITLE : Entitlement Medicaid Specialist (Part-Time)

REPORTSTO: Director of Entitlements

LOCATION: Manor: 219 East 121st St. New York, NY 10035

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, 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
• Ability Assist Counseling Services (through The Hartford)
• 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

MAJOR FUNCTIONS

Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office, Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and 820 programs.

SPECIFIC DUTIES & RESPONSIBILITIES

• Conduct daily comprehensive review of consumers’ interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay
• Process applications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace
• Daily Data Entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab
• Assist consumers with the selection of a Managed Care and NY State Market Place
• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare)
• Process restrictions through the Managed Care System (MCS)
• Prepare daily 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
• Performs related or similar duties assigned by Director

REQUIREMENTS:

• Experience with Medicaid and Managed Care and in Human Service Field
• Background with HRA/DSS/SSI/SSD benefits, Recertifications, Medicaid, managed care plans,
• Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking sk ills

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.