Medicaid Eligibility & Payment Reconciliation Specialist

Access Healthcare; New Jersey; On-site; USD 52,000 - 76,000; Full time

Job summary

Access Healthcare is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and reconcile payments for Medicare Advantage members. This role demands meticulous attention to detail, strong analytical skills, and the ability to navigate multiple systems.

You will collaborate with internal teams to ensure compliance with state and federal regulations and contracts, perform monthly revalidations, investigate discrepancies, and document findings for audit trails.

Qualifications

• High School Diploma or equivalent required; associate's or bachelor's degree preferred.
• 1+ years of experience in healthcare administration, eligibility verification, or related field.
• Strong knowledge of Medicaid eligibility rules and regulations; experience with Texas Medicaid portals is a plus.
• Proficiency navigating state Medicaid portals (Texas Medicaid Client Portal, TexMed Connect).
• Experience with Change Healthcare, Orinoco or similar healthcare data systems is preferred.

Responsibilities

• Eligibility Verification: perform monthly Medicaid eligibility revalidation checks for members.
• Eligibility Research: investigate discrepancies using state portals and other resources.
• Disenrollment Processing: manage disenrollment actions for loss of eligibility and related notices.
• Payment Reconciliation: reconcile capitated payments against eligibility; analyze discrepancies.
• Documentation and Reporting: maintain records and flag discrepancies to internal teams.
• Collaboration: work with internal teams to ensure seamless eligibility and payment processes.
• Compliance: adhere to state and federal regulations and internal policies.

Skills

Analytical

Communication

Independent worker

Team collaboration

D-SNP experience

Education

High School Diploma

Associate's or Bachelor's degree preferred

Tools

Change Healthcare

Orinoco

TexMed Connect

Medicaid portals

Job description

Access Healthcare is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and reconcile payments for Medicare Advantage members. This role demands meticulous attention to detail, strong analytical skills, and the ability to navigate multiple systems.

You will collaborate with internal teams to ensure compliance with state and federal regulations and contracts, perform monthly revalidations, investigate discrepancies, and document findings for audit trails.