Medicaid Eligibility Consultant II

University of Massachusetts Medical School; Westborough (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

University of Massachusetts Medical School seeks a Medicaid Eligibility Consultant II to support Medicaid eligibility and program integrity initiatives. You will analyze data, develop project plans, and collaborate with state agencies to align policies with IT systems.

The role requires 3–5 years in a related field, strong communication skills, and experience with Medicaid rules. Travel to client sites weekly is expected.

Qualifications

• Bachelor's degree or equivalent in a related field.
• 3–5 years of experience in a business-related field.
• Extensive knowledge of Medicaid policies and procedures.
• Familiarity with Medicaid systems and regulatory requirements.
• Proven communication and project management skills.

Responsibilities

• Perform complex analyses to support Medicaid eligibility and program integrity projects.
• Develop and track project plans, timelines, and documentation.
• Participate in multi-agency workgroups and client meetings.
• Assist with testing, system design, and defect resolution.
• Prepare presentations and marketing materials for clients.
• Support procurement processes (RFI/RFP) and cost analyses.
• Contribute to financial forecasting and savings initiatives.

Skills

Verbal communication

Written communication

Project management

Travel flexibility

Education

Bachelor's degree in business/health policy/public administration

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Overview

Under the general direction of the Senior Associate or designee, the Medicaid Eligibility Consultant II will assist in the development of contracts with state agencies; both in and out of state. The Medicaid Eligibility Consultant II should be an insightful, detail-oriented professional with Medicaid-related experience, excellent analytical and organizing skills who is able to apply that skill set to support both Medicaid Eligibility and Program Integrity Initiatives as well as the design, development and implementation of Medicaid eligibility systems.

This position will focus primarily on Medicaid member Eligibility and Program Integrity initiatives. The goals of these initiatives are to ensure member eligibility records are accurate and aligned across Medicaid systems, resulting in program savings, improved program integrity, compliance with federal and state regulations, and an improved member experience. This position will develop, track, and support the project plans, timelines, and documentation. Additionally, the role will be responsible for analyzing eligibility datasets and systems to make appropriate recommendations to the team and the client.

Responsibilities

Responsibilities

• Conduct complex analysis to support of Medicaid eligibility and program integrity projects in and out of state.
• Perform research & development analysis relevant to Medicaid eligibility and/or program integrity revenue management/cost savings projects as assigned.
• Contribute to the development of program and project expansion plans.
• Contribute to the development of presentations and the preparation of marketing materials to clients.
• Provide on-site support to senior staff during client visits and meetings
• Participate in the development of agreements between public entities and the University.
• Participate in the development of Medicaid systems on behalf of the client Medicaid agency:
• Serve as a Supporting Subject Matter Expert (SME) in Medicaid eligibility regulations, operations, and processes to support the design, development, and implementation of changes to Medicaid MAGI and non-MAGI eligibility systems.
• Assist with presenting Medicaid agency business needs and strategic vision in systems development activities and ensure they align with agency objectives.
• Participate in multi-agency workgroups supporting the development of a common eligibility application.
• Participate in meetings with the systems’ upstream and downstream stakeholders to assess needs and provide solutions.
• Attend business and system design sessions;
• Review, provide feedback and approve appropriate business system design requirements;
• Attend regularly scheduled and ad hoc meetings virtually and onsite; and
• Assist with testing and resolution of system defects.
• Support procurement processes such as Request for Information (RFI) and Request for Proposal (RFP) development.
• Contribute to project forecasting and complete assigned cost analysis tasks in support of financial planning and savings initiatives.
• Participate in presentations to staff regarding success, merits of initiative, etc.
• Independently research, develop, and prepare work and implementation plans in support of project and initiatives. Complete assigned projects from start to finish.

Qualifications

Qualifications

• Bachelor's Level Degree or equivalent in a business, health policy, social service, or public administration related field
• 3 to 5 years of experience in a business related field
• Extensive and in-depth knowledge of Medicaid policies, programs and procedures and the ability to integrate this knowledge with new and existing IT systems.
• Familiarity working with complex technical, systems and/or programs issues affecting Medicaid and its services to members.
• Strong verbal and written communication skills.
• Must have knowledge of state and federal regulations as they apply to public assistance programs
• Demonstrated experience in Microsoft Word, Excel and PowerPoint
• Demonstrated project management skills
• Ability to travel to the client and/or off- site locations weekly