Medicaid Eligibility Consultant II

UMass Med School; Westborough (MA); On-site; USD 80,000 - 90,000; Full time

Job summary

UMass Medical School in Westborough, MA is seeking a Medicaid Eligibility Consultant II to help shape eligibility and program integrity initiatives. This role focuses on ensuring member eligibility accuracy across Medicaid systems, supporting contract development with state agencies, and driving improvements in eligibility workflows.

The position requires Medicaid knowledge, strong analytical capabilities, and the ability to collaborate with multiple stakeholders on system design, testing, and

Qualifications

• Bachelor's degree or equivalent in a business, health policy, public administration, or related field.
• 3–5 years of experience in a business-related field.
• Extensive Medicaid policies, programs and procedures knowledge and ability to integrate with IT systems.
• Familiarity with complex technical, systems, or programs issues affecting Medicaid services.

Responsibilities

• Conduct complex analysis to support Medicaid eligibility and program integrity projects in and out of state.
• Perform research and development analysis related to Medicaid eligibility and cost-saving projects.
• Contribute to development of program and project expansion plans and client materials.
• Provide on-site support during client visits and meetings.
• Participate in development of Medicaid systems for the client agency and act as SME for MAGI and non-MAGI eligibility systems.
• Assist with presenting business needs and aligning system design with agency objectives.
• Participate in multi-agency workgroups to develop a common eligibility application.
• Attend design sessions and review/approve business system design requirements.
• Assist with testing and resolution of system defects and procurement processes (RFI/RFP).
• Contribute to project forecasts and cost analyses for financial planning.

Skills

Communication skills

Education

Bachelor's degree (business/health policy)

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Medicaid Eligibility Consultant II

Minimum Salary

USD $80,000.00/Yr. - USD $90,000.00/Yr.

Job Location

US-MA-Westborough

Shift

Exempt

Exempt/Non-Exempt Status

Non Union Position -W60- Non Unit Professional

Union Code

Non Union Position - Non Unit Professional (W60)

Position Type

Full-Time

Number of Openings

1

Requisition Number

2026-52226

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

• 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

• 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