Medicare/Medicaid Eligibility Specialist, Fully Remote

Centauri Health Solutions; Town of Texas (WI); Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a compassionate Medicare/Medicaid Eligibility Specialist to assist health plan members in navigating government assistance programs. In this fully remote role, you'll conduct outreach, support applications, and ensure compliance with state and federal regulations. This position offers a rewarding environment with opportunities for professional growth, competitive compensation, and a comprehensive benefits package. If you have a strong desire to help others and possess the necessary experience, this role could be your next career move.

Benefits

Generous paid time off

Matching 401(k) program

Tuition reimbursement

Annual salary reviews

Comprehensive health plan

Volunteer activities on company time

Development opportunities

Bonus eligibility

Qualifications

• Experience with Medicare/Medicaid programs and eligibility screening is highly valued.
• Strong communication and customer service skills are essential for this role.

Responsibilities

• Conduct telephonic outreach for Medicaid program applications and recertifications.
• Collaborate with government offices to ensure accurate application processes.

Skills

Medicare/Medicaid program experience

Customer service skills

Communication skills

Organizational skills

Analytical skills

Critical thinking

Fast-paced environment management

Education

Bachelor’s Degree

Associate’s Degree

Tools

Microsoft Office

Excel

Job description

Medicare/Medicaid Eligibility Specialist, Fully Remote

Texas, USA Req #3316

Tuesday, April 8, 2025

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500 list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com.

Role Overview:

The Medicare/Medicaid Eligibility Specialist works with health plan members to determine eligibility for Social Security disability benefits. The Medicare/Medicaid Eligibility Specialist advocates and assists Medicare beneficiaries apply to and requalify for government assistance programs. The Medicare/Medicaid Eligibility Specialist builds trusting relationships with members and provides critical application assistance.

Role Responsibilities:

• Conducts telephonic outreach activities for members who need to apply or recertify and are potentially eligible for various Medicaid programs including the Medicare Savings Programs.
• Collaborates with government offices to accurately complete the application and recertification process.
• Secures documentation for Medicaid/MSP renewal applications if needed for members.
• Attention to detail by adhering to state requirements and securing supporting documentation.
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, and make accurate and descriptive documentation.
• Participates as required in operational development programs.
• Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicare programs and Medicaid Outreach Operations.
• Demonstrates behaviors, actions, and attitudes that reflect our vision, mission, and values.
• Understand and agree to role-specific information security access and responsibilities.
• Ensure safety and confidentiality of data and systems by adhering to the organization's information security policies.
• Read, understand, and agree to security policies and complete all annual security and compliance training.

Role Requirements:

• Medicare/Medicaid program experience, and experience with screening for Medicaid eligibility is a strong plus.
• Expertise and knowledge of Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS), and the Medicare Savings Program (MSP).
• Strong working knowledge with Microsoft Office programs, and some experience with Excel.
• Excellent oral communication skills; ability to communicate with elderly individuals and governmental personnel.
• 2-3 years related experience with direct consumer interaction.
• Outstanding customer service and communication skills.
• Strong organizational, analytical, critical thinking, and customer service skills.
• Ability to analyze and interpret governmental program criteria.
• Ability to manage a fast-paced environment.
• Must be able to navigate through multiple databases/monitors with a minimum typing speed of 45 wpm.
• Telephone experience and ability to interact and decipher information via telephonic or correspondence inquiries.
• Strong subject matter expertise of Medicaid programs regulations and industry standards.
• Case management experience or related experience / intermediate.
• A compassionate and empathetic nature with a strong desire to help and make a difference.
• Bachelor’s or Associate’s Degree is a plus.

We believe strongly in providing employees a rewarding work environment in which to grow, excel, and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities. This position is bonus eligible in accordance with the terms of the Company’s plan.

Centauri currently maintains a policy that requires several in-person and hybrid office workers to be fully vaccinated. New employees in the mentioned categories may require proof of vaccination by their start date. The Company is an equal opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.

Factors which may affect starting pay within this range may include geography/market, skills, education, experience, and other qualifications of the successful candidate.