Medicare & Medicaid Eligibility Specialist, Remote

Centauri Health Solutions, Inc.; Georgia (VT); Remote; USD 43,000 - 55,000; Full time

Job summary

A leading company in healthcare services is seeking a Medicare & Medicaid Eligibility Specialist. The role involves assisting clients with eligibility for government programs and ensuring compliance with state regulations. Ideal candidates will possess strong communication skills and experience in Medicaid programs. Join a rewarding environment with competitive compensation and excellent benefits.

Benefits

Generous paid time off

Matching 401(k) program

Tuition reimbursement

Health plan benefits

Volunteer opportunities

Qualifications

• Expertise in Medicaid and Medicare programs required.
• 2-3 years consumer interaction experience necessary.
• Compassionate nature to assist elderly individuals.

Responsibilities

• Conduct outreach for eligibility assessments for programs.
• Assist clients with application processes and recertification.
• Ensure compliance with state regulatory standards.

Skills

Customer Service

Communication

Organizational Skills

Critical Thinking

Analytical Skills

Education

Bachelor’s or Associate’s Degree

Tools

Microsoft Office

Excel

Job description

Medicare & Medicaid Eligibility Specialist, Remote

Georgia, USA

Job Description

Posted Wednesday, June 4, 2025 at 7:00 AM

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, visitwww.centaurihs.com.

Role Overview:

The Medicare/Medicaid Eligibility Specialist works with health plan members to determine eligibility for 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 provide 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, meet ongoing corporate compliance standards, 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 organizations 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 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 inquires
• 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 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.

This position is bonus eligible in accordance with the terms of the Company’s plan.