Temporary Medicaid Specialist

Blue Cross & Blue Shield of Rhode Island; United States; Hybrid; USD 38,000 - 52,000; Full time

Benefits offered by this job

Remote and hybrid options

Paid time off

Tuition reimbursement

Student-loan repayment assistance

Health insurance

Mental health programs

Bonuses

Investment plans

Volunteer time off

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a Medicaid Eligibility Specialist in Providence to assess prospective members, explain Medicaid rules, and serve as a liaison with EOHHS. Hybrid and remote options are available based on role.

You will support annual redeterminations, verify documentation, log progress in SFDC, and participate in ongoing training to ensure timely processing. A high school diploma and up to two years of related experience are required.

Qualifications

• High school diploma or GED required.
• Up to two years of related professional experience.
• Excellent interpersonal and communication skills.
• Working knowledge of Medicaid rules and computer software.
• Ability to communicate to various levels of personnel.
• Proficient computer navigation and data organization.
• Ability to work independently and meet deadlines.
• Sound judgment and time management.
• Written and verbal communications skills.
• Ability to collect and organize data.

Responsibilities

• Conduct eligibility assessment of prospective Medicaid members.
• Explain Medicaid rules and regulations to members.
• Serve as liaison between prospective members and EOHHS.
• Assist with redetermination by verifying eligibility and required documents.
• Follow up with members and EOHHS caseworkers to ensure timely processing.
• Maintain log of Medicaid eligibility and complete re-determinations.
• Document progress notes in SFDC.
• Participate in ongoing training.
• Occasionally perform home visits to complete applications.
• Perform other duties as assigned.

Skills

Interpersonal skills

Negotiation

Communication

Time management

Data organization

Independent work

Judgment

Written & verbal communications

Documentation skills

Education

High school diploma or GED

Tools

SFDC

Microsoft Office

Job description

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

• flexible work arrangements that include remote and hybrid opportunities and paid time off.
• We provide tuition reimbursement and assist with student-loan repayment.
• We offer health, dental, and vision insurance as well as programs that support your mental health and well-being.
• We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
• our associates receive additional paid time to volunteer.

What you will do

• Conduct eligibility assessment of prospective members for Medicaid enrollment.
• Communicate Medicaid rules and regulations to members and prospective members.
• Serve as a liaison between prospective members and EOHHS (Medicaid).
• Assist existing members with Medicaid redetermination process by verifying members’ eligibility and by assisting with identification of necessary supporting documentation.
• Initiate and maintain proper follow‑up with the member/prospective member and EOHHS caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
• Maintain a log of Medicaid eligibility and complete all re‑determinations for members.
• Document progress notes to member/prospect file in SFDC.
• Participate in ongoing, comprehensive training programs as required.
• On occasion, perform home visits to complete all Medicaid applications on all new enrollees and re‑determinations within a reasonable time frame.
• Perform other duties as assigned.

What you need to succeed

• High school diploma or GED
• Up to two years of previous professional experience in a related position
• Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic.
• Working knowledge of Medicaid eligibility requirements, computer programs and software.
• Ability to communicate and present information to various levels of personnel.
• Computer navigation skills
• Written and verbal communications skills
• Time management skills
• Ability to collect and organize data
• Ability to work independently
• Ability to meet established time and quality standards
• Ability to exercise sound judgment

Location

Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal.

We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week

Permitted to reside in the following states, pending approval from the Human Resources Department:

• Arizona
• Connecticut
• Florida
• Georgia
• Louisiana
• Massachusetts
• North Carolina
• Oklahoma
• Rhode Island
• South Carolina
• Texas
• Virginia

BCBSRI is an equal opportunity employer.

Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.