Entitlement Medicaid Specialist

Odyssey House INC•New York, NY

5d•Onsite

About The Position

Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages—and across all five boroughs—beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration. If that sounds different than other treatment programs, you’re right. Because Odyssey is where recovery gets real.

Requirements

BA Degree preferred
Experience with Medicaid Managed Care; Human Services Field
Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment
Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking
Notary Public Stamp

Responsibilities

Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office, Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and 820 programs.
Conduct daily comprehensive review of consumers’ interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay
Case conference difficult cases with the Director for guidance and support to ensure funding for 819 and Part 820 programs are obtained in a timely fashion
Conduct interviews on new admissions for HRA/DSS/Medicaid/SSI/SSD/Self-Pay
Expedite consumers with the selection of Managed Care Organization, assist with the NY State Market Place at point of admissions and upon Medicaid Eligibility
Daily Data Entry of Medicaid Managed Care coverage / Medicare / Private Insurance / MAT in AWARDS, E-Lab and LabCorp Portal
Daily update the Entitlement 820 Reports with consumers’ coverage
Navigate Epaces (eMedNY) / Inovalon / STARS / SAAMS / AWARDS / WTW / Manage Care System Portals for coverage
Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, Medicare, and Private Insurance)
Process Medicaid applications and recertifications for consumers through the Department of Social Services, NY State Exchange/Marketplace
Investigate Medicaid disparities related to county / deferral / eligibility / denial / dropped / recertification
Identify and process consumers with Medical / Pharmacy / Out-Patient restrictions through the Managed Care Organization and Managed Care System (MCS)
Resolve problematic Medicaid Managed Care issues for Part 820 coverage
Complete and submit bi-weekly 820 Medicaid Managed Care Reports
Complete weekly Medicaid Manage Care Reports for five residential programs to reflect consumers’ coverage for the Pharmacy, Medical department and LabCorp
Other relevant duties as assigned

Benefits

A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher