Medicaid Eligibility Specialist

Conduent•Albuquerque, NM

1d•Hybrid

About The Position

Conduent has an immediate opening for the Medicaid Eligibility Specialist Position. This is a great opportunity to learn about the Medicaid Program. The Medicaid Eligibility Specialist reports directly to the Outreach Supervisor. They conduct presentations throughout the community on the New Mexico Medicaid Program, meeting with groups or individuals. The role involves providing accurate information about the New Mexico Medicaid Program and assisting beneficiaries with enrollment and eligibility for potential and existing New Mexico Medicaid beneficiaries. The specialist processes eligibility applications, determines eligibility for the program, and enters eligibility information into a web-based computer system, referencing other NM-specific databases as appropriate. They follow up with beneficiaries via correspondence, perform file updates as information comes in, and assess service/information needs. This role also supports the research process unit for the SBE (state-based exchange) and acts as a subject matter expert (SME) with strong knowledge of all systems used for processing. The specialist determines eligibility for the NM Medicaid Program according to NM Medicaid Care regulations/guidelines by reviewing documentation, accurately entering data into a web-based computer system, and following procedures for running automated eligibility rules. They prepare correspondence for missing information, make outbound calls to obtain, clarify, or validate information, and process applications while maintaining an error rate of 5% or below. Additionally, the role involves assisting/training new staff, assisting in the call center when needed, maintaining good attendance and punctuality, and working independently on projects. The specialist must adhere to changes in policy and procedure and build relationships with the community and advocacy groups. They provide administrative support to business operations by performing processing tasks such as data entry, scanning, mail sorting, or similar activities, electronic portal use, media conversation, and content storage and retrieval. Occasionally, going into the office may be required.

Requirements

Must at least 18 years of age or older
Have a High School Diploma or an equivalent level of education.
Must be able to submit to a pre-employment screening
Have legal authorization to work permanently in the United States without requiring a visa transfer or visa sponsorship.

Responsibilities

Conducts presentations throughout the community on New Mexico Medicaid Program.
Meet with groups or individuals.
Provide accurate information about the New Mexico Medicaid Program.
Assist beneficiaries in enrollment and eligibility assistance for potential and existing New Mexico Medicaid beneficiaries.
Processes eligibility applications and determines eligibility for the program.
Enters eligibility information into a web-based computer system and references other NM-specific databases as appropriate.
Follows up with beneficiaries with correspondence, performs file updates as information comes in, and assesses service/information.
Support the research process unit for the SBE (state-based exchange) and seasoned processor with strong knowledge of all systems used for processing – SME (subject matter expert).
Determine eligibility for NM Medicaid Program according to the NM Medicaid Care regulations/guidelines by reviewing documentation to accurately enter data into a web-based computer system and following procedures for running automated eligibility rules.
Prepare correspondence for missing information as appropriate.
Make outbound calls to obtain, clarify, or validate the information.
Process applications while maintaining an error rate of 5% or below.
Assist/train new staff and assist in the call center when needed.
Maintain good attendance and punctuality and work independently on projects.
Adhere to changes in policy and procedure and build relationships with the community and advocacy groups.
Provides administrative support to the business operations by performing processing tasks such as data entry, scanning, mail sorting or similar activities, electronic portal, media conversation, content storage and retrieval.
Occasionally, you will have to go into the office if needed.