Remote Appeals & Eligibility Specialist

Minnesota Department of Human Services; Saint Paul (MN); Remote; USD 37,000 - 54,000; Full time

Job summary

Minnesota Department of Human Services is seeking an Appeals Specialist to support the Eligibility Appeals Unit in processing MHCP eligibility appeals. You will conduct intake, perform initial reviews, and coordinate information with multiple stakeholders to ensure accuracy and timeliness.

The role requires interpreting health care policies, applying statutes, and exercising independent judgment in a deadline-driven environment. Telework is eligible for Minnesota residents with approval.

Qualifications

• Three (3) years of recent experience determining eligibility for Minnesota Health Care Programs such as Medical Assistance and MinnesotaCare.
• Experience with eligibility and financial technology systems (such as METS, MAXIS, MMIS).
• Proven experience communicating complex health care policies and program constraints effectively, both orally and in writing to a broad audience.
• Experience reading, interpreting and implementing health care eligibility policies and procedures.

Responsibilities

• Conduct appeal intake and preliminary review, determine continued benefit eligibility and coordinate appeal information.
• Coordinate with Appeals Division, service agencies, MNsure, DHS program areas, appellants and stakeholders to ensure appeals are processed accurately and timely.
• Maintain accurate appeal information, identify process improvements and refer applicable cases for potential overpayment assessment.

Skills

Eligibility experience

Tech systems (METS/MAXIS/MMIS)

Policy communication

Education

Bachelor’s degree or higher in health care administration or related field

Job description

Minnesota Department of Human Services is seeking an Appeals Specialist to support the Eligibility Appeals Unit in processing MHCP eligibility appeals. You will conduct intake, perform initial reviews, and coordinate information with multiple stakeholders to ensure accuracy and timeliness.

The role requires interpreting health care policies, applying statutes, and exercising independent judgment in a deadline-driven environment. Telework is eligible for Minnesota residents with approval.