Medicaid/Medicare Services Specialist I

Kentucky Personnel Cabinet • Frankfort, KY

1d

About The Position

The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing programs, services and supports that protect and promote the health and well-being of all Kentuckians and their communities.

The Department for Medicaid Services, Division of Program Integrity is responsible for guarding Medicaid against fraud, waste and abuse of program benefits by providers and members, and compliance with federal and state rules and regulations. The Medicaid/ Medicare Services Specialist I position offers a wide-range of learning opportunities, including networking as this position will work closely with Providers, Managed Care Organizations, Management, and sister-agencies. Seeking a motivated person that will work in a high-volume contact center for the Department for Medicaid Services, Provider Enrollment where identifying customers' needs quickly, clarifying information, and researching every issue is required in order to provide resolutions to issues. To be successful, candidates should be professional, polite, and able to deal with difficult and stressful situations, and able to apply state and federal regulations in decision making.

Learn more about us at: https://chfs.ky.gov/agencies/dms/pages/default.aspx

Requirements

• EDUCATION: Graduate of a college or university with a bachelor's degree.
• EXPERIENCE, TRAINING, OR SKILLS: NONE
• Substitute EDUCATION for EXPERIENCE: NONE
• Substitute EXPERIENCE for EDUCATION: Experience in Medicaid and/or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development or human service or health care administration, insurance billing and/or claims will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year-for-year basis.
• SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE

Responsibilities

• Provides specialized assistance to Medicaid providers, staff within the Department for Medicaid Services (DMS), and Medicaid Contractors.
• Responds to providers and Credentialing Agents inquiries on KY DMS Provider Enrollment eligibility, submission documents, and application status, as well as maintenance required on provider file. Collecting information about caller and provider, verifies in different information systems, and enters information into database. Entering information into Customer Relationship Management (CRM) system to assist with call-tracking and quality assurance.
• Provides assistance to providers and government agencies through oral and written response to inquiries.
• Requires the ability to work independently and manage time effectively, as well as to work with difficult issues. Implements policy changes as appropriate.
• Performs research of state and federal statutes and regulations relative to provider enrollment and remains abreast of all changes to state and federal laws.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level