Medicaid Eligibility Consultant II

University of Massachusetts Medical School•Westborough, MA

About The Position

Under the general direction of the Senior Associate or designee, the Medicaid Eligibility Consultant II assists in developing contracts with state agencies, both in and out of state. This detail-oriented professional applies Medicaid-related experience, analytical skills, and organizational skills to support Medicaid Eligibility and Program Integrity initiatives and the design, development, and implementation of Medicaid eligibility systems. The role conducts analysis and research, contributes to project and program expansion planning, develops presentations and marketing materials, supports senior staff during client visits, and participates in agreements between public entities and the University. It also supports client Medicaid agencies in developing systems, including serving as a subject matter expert on eligibility regulations, operations, and processes; representing agency needs in systems development; participating in workgroups and design sessions; reviewing system requirements; and assisting with testing and defect resolution. Additional work includes supporting procurement, financial planning, project forecasting, implementation planning, and completing assigned projects from start to finish. The position requires weekly travel to clients and/or off-site locations.

Requirements

Bachelor's-level degree or equivalent in a business, health policy, social service, or public administration-related field.
Three to five years of experience in a business-related field.
Extensive and in-depth knowledge of Medicaid policies, programs, and procedures, and ability to integrate this knowledge with new and existing IT systems.
Familiarity working with complex technical, systems, and/or program issues affecting Medicaid and its services to members.
Strong verbal and written communication skills.
Knowledge of state and federal regulations as they apply to public assistance programs.
Demonstrated experience with Microsoft Word, Excel, and PowerPoint.
Demonstrated project management skills.
Ability to travel weekly to client and/or off-site locations.

Responsibilities

Conduct complex analysis to support Medicaid eligibility and program integrity projects in and out of state.
Perform research and development analysis for Medicaid eligibility and/or program integrity revenue management and cost-savings projects.
Contribute to program and project expansion plans.
Help develop presentations and prepare marketing materials for clients.
Provide on-site support to senior staff during client visits and meetings.
Participate in developing agreements between public entities and the University.
Serve as a supporting subject matter expert in Medicaid eligibility regulations, operations, and processes for the design, development, and implementation of changes to Medicaid MAGI and non-MAGI eligibility systems.
Help present Medicaid agency business needs and strategic vision during systems development and ensure alignment with agency objectives.
Participate in multi-agency workgroups developing a common eligibility application.
Participate in meetings with systems’ upstream and downstream stakeholders to assess needs and provide solutions.
Attend business and system design sessions; review, provide feedback on, and approve appropriate business system design requirements.
Attend regularly scheduled and ad hoc meetings virtually and onsite.
Assist with testing and resolving system defects.
Support procurement processes, including Request for Information and Request for Proposal development.
Contribute to project forecasting and complete assigned cost analysis tasks supporting financial planning and savings initiatives.
Participate in presentations to staff about initiative success and merits.
Independently research, develop, and prepare work and implementation plans supporting projects and initiatives.
Complete assigned projects from start to finish.