Medicaid Eligibility Specialist

Cuyahoga County Board of Developmental Disabilities; Cleveland (OH); On-site; USD 56,000 - 63,000; Full time

Benefits offered by this job

Over 40 paid days off a year

Pension through Ohio PERS

Major Medical insurance

Free Dental, Vision Life, andTemporary

Professional Development Reimbursement

Mileage Reimbursement at IRS rate

Flexible Spending Account

Tuition Reimbursement

Annual Pay Increases

Job summary

The Cuyahoga County Board of Developmental Disabilities is seeking a Medicaid Eligibility Specialist to expedite Medicaid eligibility for HCBS waivers and to support ongoing eligibility maintenance. The role involves coordinating with SMBC staff, submitting enrollment forms, acting as Authorized Representative, resolving data issues, and ensuring timely redeterminations.

Qualifications include experience with CRIS-E, MITS, and Medicaid processes; familiarity with HCBS waivers and DD programs;

Qualifications

• Two years’ work experience with CRIS-E system, MITS, and Medicaid eligibility process preferred.
• Two years’ work experience with HCBS waiver programs preferred.
• Two years’ work experience with programs for persons with DD desirable.

Responsibilities

• Maintain daily communication with SMBC staff and caseworkers regarding eligibility and interviews.
• Coordinate forms for initial Medicaid enrollment, SNAP, and renewals; review for errors.
• Act as Authorized Representative and process notices, verifications, and hearings.
• Verify eligibility using read-only Medicaid programs and respond to general questions on benefits.
• Maintain data in OnBase and Gatekeeper; document changes and transfers.
• Attend meetings with staff, providers, payees, and guardians as needed.
• Perform MAC activities in line with Waiver rules and requirements.

Skills

Communication skills

Interpersonal skills

Education

High school diploma

Tools

CRIS-E system

MITS

HCBS waiver programs

Medicaid eligibility process

Job description

The Cuyahoga County Board of Developmental Disabilities (Cuyahoga DD) is seeking a Medicaid Eligibility Specialist to expedite the process of establishing Medicaid eligibility in order to enroll individuals in Home and Community-Based Services (HCBS) waivers; assists with maintenance of Medicaid eligibility through Medicaid and HCBS redetermination processes. The nature of work will include but is not limited to the following

• Maintain daily communication and consultation with the Specialized Medicaid Benefits Center (SMBC) staff, Community Medicaid Caseworkers, and Support Administrators regarding scheduled appointments, required verifications to complete eligibility, and results of initial and renewals interviews for waiver applicants/enrollees.
• Respond to a high volume of phone calls and emails from Cuyahoga DD and SMBC staff, walk-ins from providers, payees, and individuals/guardians regarding Medicaid eligibility, scheduled or missed interview appointments with SMBC, Medicaid verification, and other concerns for recommendation or resolution.
• Coordinate and collect applicable forms for initial Medicaid enrollment, SNAP benefit, and renewals from Cuyahoga DD staff, individuals/guardians, payees, and providers to submit to SMBC. Review applications and communicate with Cuyahoga DD staff regarding errors and required corrections for Medicaid enrollment.
• Act as Authorized Representative for Cuyahoga DD on behalf of individuals needing this service. On behalf of services include receiving and processing JFS and ODM notices, gathering additional required verifications to complete initial and renewal packets, maintaining a log to track case specific communication, scanning submitted verifications to SMBC into OnBase, and attending interviews and Medicaid hearings.
• Work closely with SMBC to problem solve and resolve data discrepancies, PLOMS, billing, and level of care issues. Expedite pending Medicaid eligibility for waiver applicants and communicate as necessary with Cuyahoga DD staff.
• Use read-only access to Medicaid Programs (e.g. AEFMI and MITS) to verify eligibility for individuals on Medicaid, Social Security, Medicare, and other active Medicaid Benefits (e.g. HCBS, OHCW, RSS, SNAP, and Passport). Review documents and respond to general questions related to Social Security and Medicare benefits.
• Provide technical assistance to CMS staff, individuals, and authorized representatives regarding Medicaid documents and billing issues. Analyze MITS information to diagnose and resolve billing issues for individuals on waivers or in Intermediate Care Facilities.
• Maintain a high volume of data in Cuyahoga DD’s OnBase and Gatekeeper software packages pertaining to Medicaid enrollment. Report and verify changes in demographic, employment wages, and county to county transfers to SMBC/CDJFS to maintain benefits.
• Attend meetings as needed with Cuyahoga DD staff, providers, payees, and individuals/guardians at Cuyahoga DD, SMBC, or CDJFS offices.
• Perform Medicaid Administrative Claiming (MAC) activities that are applicable to this position, and are required by Waiver rules, policies and procedures. Position functions will be 100% MAC billable in a manner consistent with requirements of DODD and ODM.

PERSONAL CONTACT

Frequent personal contact, telephone calls and written communications with Cuyahoga DD staff, individuals, families, community agencies and other state/county agencies.

SALARY

• SALARY The starting salary range for this position will be between $56,385.00 to $63,000.00 The actual starting salary for a new hire will be determined based on many factors including the breadth and depth of the knowledge, skills, education and experiences brought by the candidate, while considering not only internal equity but also the budgetary constraints which hold us to the range posted here.

FANTASTIC BENEFITS All newly hired employees in this position walk through the door earning

• Over 40 paid days off a year, including holidays.
• A great government Pension through Ohio PERS.
• Major Medical insurance.
• Free Dental, Vision Life, and Temporary disability Insurance
• Professional Development Reimbursement each year.
• Membership dues reimbursement each year.
• Mileage Reimbursement at the IRS rate.
• Flexible Spending Account
• Tuition Reimbursement
• Annual Pay Increases, and so much more.

Remote Work

Our positions are not 100'% remote. This position will work three (3) days in office each week and two (2) days can be remote (home) each week. Although the Cuyahoga DD has four (4) buildings, when you are required to be in-office, at least two of those three days must be at the positions home base located in Highland Hills, Ohio at the Green Road Services Center.

• High school diploma required.
• Two years’ work experience with CRIS-E system, MITS, and Medicaid eligibility process preferred.
• Two years’ work experience with HCBS waiver programs is preferred.
• Two years successful work experience with programs for persons with DD is desirable.
• Valid state of Ohio driver's license and continued maintenance of excellent driving record.

Application Deadline

Open until filled.

Equal Opportunity, Diversity, and Inclusion

The Cuyahoga County Board of DD is committed to treating every individual, family, employee, and applicant with dignity, respect and compassion regardless of a person’s sex, ancestry, national original, race, color, age, religion, disability, military or veteran status, sexual orientation, gender identity/gender expression, genetic information, or social, economic or political affiliation. Compassion, trust, and mutual respect are at the core of our commitment to diversity and inclusion. The Cuyahoga County Board of DD fosters and promotes an inclusive environment that leverages the unique contributions of diverse individuals and organizations in all aspects of our work. We know that by bringing diverse individuals and viewpoints together we can collectively and more effectively create opportunities for a better life for the individuals we support. Diversity and inclusion are at the heart of what it means for people with developmental disabilities to live, learn, work, and play in the community.

Cuyahoga DD is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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Background Checks Disclosure

All tentative job offers are made with the understanding that prospective new employees pass a drug test and criminal records check prior to being hired. For a list of disqualifying criminal offenses please see the rule HERE.