Eligibility and Enrollment Specialist - Remote

Overview

The Eligibility and Enrollment Specialist at Healthy Alliance plays a crucial role in supporting community members and providers throughout the eligibility process, ensuring accurate information and timely facilitation of services for Medicaid members.

In Short

• Primary contact for enrollment and eligibility inquiries.
• Handles phone calls and emails to assist Medicaid members.
• Validates enrollment through NYS DOH systems.
• Ensures accurate records through verification and reconciliation.
• Liaison between internal departments and MCOs.
• Facilitates eligibility determinations for HRSN services.
• Monitors enrollment data for outreach.
• Maintains documentation for service provision.
• Supports compliance reviews and escalates risks.
• Contributes to key performance metrics.

Requirements

• Relevant education in social or clinical work.
• Experience with legal and procedural documents.
• Experience with community members and care teams.
• Knowledge of federal, state, and local regulations.
• Strong customer service skills.
• Ability to manage sensitive conversations.
• Critical thinking and decision-making skills.
• Proficiency in MS Office Suite.
• Ability to work in a hybrid environment.
• Attention to detail and strong documentation skills.

Benefits

• Competitive compensation package.
• Comprehensive insurance benefits.
• 401K with company match.
• Unlimited paid time off after 90 days.
• Company-sponsored training opportunities.
• Flexible work schedules.
• Workplace that values safety and diversity.