Medicaid Eligibility & Payments Specialist

Paycom - ATS; Hackensack, Northern (NJ, KY); Híbrido; USD 37.000 - 46.000; Jornada completa

Descripción de la vacante

Paycom - ATS in Hackensack, NJ is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and support monthly payment reconciliation for members. The role requires meticulous attention to detail, strong analytical skills, and the ability to navigate Change Healthcare, Orinoco, TexMed Connect, and client portals.

You will investigate discrepancies, manage disenrollment actions, and document findings while ensuring compliance with state and federal regulations and internal

Formación

• High school diploma or equivalent required; degree preferred.
• 1+ year experience in healthcare administration or eligibility verification.
• Knowledge of Medicaid rules and regulations in Texas.
• Experience with state Medicaid portals and data systems.
• Familiarity with medical terminology and coding.
• Strong analytical, problem-solving, and communication skills.
• Ability to work independently and as part of a team.

Responsabilidades

• Verify Medicaid eligibility for members monthly via state portals.
• Research and resolve eligibility discrepancies across systems.
• Process disenrollment actions per notices and CMS transactions.
• Reconcile capitated payments against member eligibility monthly.
• Document findings and maintain accurate records.
• Collaborate with internal teams to ensure compliant processes.
• Adhere to regulations and internal policies.

Conocimientos

Analytical

Problem-solving

Communication

Independent worker

Medicare knowledge

Educación

High School Diploma or equivalent

Associate's or Bachelor's degree preferred

Herramientas

Orinoco

Change Healthcare

TexMed Connect

Texas Medicaid Client Portal

Descripción del empleo

Paycom - ATS in Hackensack, NJ is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and support monthly payment reconciliation for members. The role requires meticulous attention to detail, strong analytical skills, and the ability to navigate Change Healthcare, Orinoco, TexMed Connect, and client portals.

You will investigate discrepancies, manage disenrollment actions, and document findings while ensuring compliance with state and federal regulations and internal