Medicaid Eligibility Specialist

Conduent State Healthcare, LLC•Albuquerque, NM

3d•Hybrid

About The Position

Conduent is seeking a Medicaid Eligibility Specialist to join their Customer Service Team. This role supports the New Mexico Medicaid Program by assisting beneficiaries with enrollment and eligibility. The specialist will process applications, determine eligibility based on program guidelines, and enter data into a web-based system. This is an opportunity to learn about the Medicaid Program and make a difference in the community.

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.

Nice To Haves

Must reside within 50 Miles Radius of Alburquerque, NM

Responsibilities

Conduct presentations throughout the community on the New Mexico Medicaid Program.
Meet with groups or individuals to provide accurate information about the New Mexico Medicaid Program.
Assist beneficiaries in enrollment and eligibility assistance for potential and existing New Mexico Medicaid beneficiaries.
Process eligibility applications and determine eligibility for the program.
Enter eligibility information into a web-based computer system and reference other NM-specific databases.
Follow up with beneficiaries with correspondence.
Perform file updates as information comes in and assess service/information.
Support the research process unit for the SBE (state-based exchange) and act as a subject matter expert (SME) with strong knowledge of all systems used for processing.
Determine eligibility for NM Medicaid Program according to the NM Medicaid Care regulations/guidelines by reviewing documentation.
Accurately enter data into a web-based computer system and follow procedures for running automated eligibility rules.
Prepare correspondence for missing information as appropriate.
Make outbound calls to obtain, clarify, or validate 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.
Build relationships with the community and advocacy groups.
Provide administrative support to 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 go into the office if needed.