Entitlement Medicaid Specialist
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
- High School / associate degree
- Experience with Medicaid and Managed Care and in Human Service Field
- Background with HRA/DSS/SSI/SSD benefits, Recertifications, Medicaid, managed care plans
- Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking skills
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
- Process applications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace
- Navigate eMedNY (Epaces) / STARS / AWARDS / Manage Care portal systems
- Daily Data Entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab
- Assist consumers with the selection of a Managed Care and NY State Market Place
- Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare)
- Process restrictions through the Managed Care System (MCS)
- Prepare daily status of consumers’ Medicaid/Managed Care/Medicare/Private Insurance status
- Review weekly consumers’ Medicaid Managed Care coverage and dropped coverage
- Prepare biweekly Medicaid Manage Care Reports to reflect current coverage
- Performs related or similar duties assigned by Director
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
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Associate degree
