• Medicaid Specialist- MLTC

    Job Locations US-NY-Staten Island
    ID 2018-1117
    Non-Clinical- MLTC
    Regular Full-Time
  • Overview

    The Medicaid Specialist will be responsible for providing assistance to current and prospective members of Extended Managed Long Term Care. The Medicaid Specialist works with members assisting in the Medicaid application process, recertification, eligibility issues; which requires extensive knowledge of current regulations, policies, and protocols governing eligibility for obtaining and retaining Medicaid.


    • Provide direct support to MLTC Department in relation to concrete Medicaid eligibility actions. 
    • Assist members with conference/warm transfer calls to HRA/LDSS as needed.
    • Maintain understanding of eligibility through NYS Medicaid Health Benefit Exchange (HIX) and NYS Local Department of Social Services (WMS) renewal protocols and regulatory requirements.
    • Assist with completion and submission of Medicaid transactions within specified timeframe to assure Medicaid coverage for new enrollees.
    • Assist with tracking the Medicaid status for members whose enrollments are delayed due to Medicaid eligibility issues – generate & mail Notice of Enrollment Delay to members and upload to electronic medical record.
    • Manage a case load to assist members by the facilitation of the Medicaid Recertification/Application process; cross reference with RS File and McKesson Expiring Recertification report.
    • Research and resolve Medicaid ineligible/recertification issues.
    • Track Medicaid cases and time frames via inbound or outbound calls to members and LDSS until eligibility is renewed or restored. 
    • Maintain active surplus list and ensure the monthly Notice of Spend Down are mailed to members and upload to the electronic medical record.
    • Serve as a resource for Medicare/Medicaid eligibility verification utilizing automated tools such as Epaces and Medicare Verification Portal & updating coverage in the computer database system.
    • Maintain accurate records and notes on member’s eligibility status and timing of recertification in the computer database system.
    • Perform other duties as assigned including, but not limited to field visits in order to assist members with the Medicaid eligibility process. 


    • Strong leadership and influencing skills
    • Critical thinking and creative problem solving skills
    • Attention to detail and highly organized
    • Ability to synthesize large amounts of information and “connect dots”
    • Strong written and verbal communication skills
    • Ability to identify, build strong relationships and utilize resources effectively – Team Player
    • Comfort with trying something new
    • Interest and aptitude to learn the complexities of government-sponsored healthcare
    • Ability to work independently on multiple endeavors at once
    • Proficiency in Excel & Word
    • Associates Degree required preferably in Human Services, Psychology or Public Administration


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