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Eligibility and Enrollment Specialist - Remote

Posted 8 weeks ago

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.

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