Medicaid Eligibility Specialist

Conduent•Albuquerque, NM

2d•Hybrid

About The Position

This is a great opportunity to learn about the Medicaid Program! Join the Conduent Customer Service Team and support the New Mexico Medicaid Program as a Medicaid Eligibility Specialist. This role involves conducting community presentations, providing accurate information about the program, and assisting beneficiaries with enrollment and eligibility. You will process eligibility applications, determine eligibility based on program regulations, and enter data into a web-based computer system. The position also requires following up with beneficiaries, performing file updates, and assessing services and information. You will also provide administrative support through tasks like data entry, scanning, and mail sorting.

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

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.