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(Archived) Medicaid Service Coordinator

Last Updated: 1/30/23

Job Description

Duties:
  • Verify and continuously monitor patient Medicaid eligibility to obtain access to services.
  • Prepare and submit monthly Managed Care Enrollment /Roster Reports and weekly encounter reports.
  • Monitor Medicaid re-certification timeframes for each active patient, and contact patient or primary caregiver in person, by phone or letter to arrange a meeting, two months prior to the Medicaid expiration date.
  • Keep up-to-date on Medicaid Managed Care and other program issues, as well as changes in Medicaid/Medicare/HMO laws, and share information with members as necessary.
  • Contributes to the teams’ efforts to treat every member with respect courtesy, and fairness in a way that provides superior customer services.
  • Assist with Managed Care, Medicare and private pay billing issues to maximize revenues.
  • Escalate Medicaid Managed Care and operational issues to Managed Care Relations Manager for resolution.
  • Assist with the accurate and timely credentialing and re-credentialing of new and existing providers with Managed Care Organizations.
  • Maintain the highest level of integrity, courtesy, and respect while interacting with members, employees and business contacts.
  • Engage patients for primary care services.
  • Participate in Health Home meetings as necessary and required, to support START’s Health Home Initiative.
  • Perform all other duties as assigned.

Background of Candidate:
  • Bachelors Degree.
  • 3 years of specific industry experience in Medicaid Managed Care or HMO
  • Experience with patient health information (PHI) databases (i.e. EPACES and eCW).
  • Familiar with Medicaid eligibility guidelines and processes (i.e Surplus).
  • Familiar with claims processing, billing and credentialing.
  • Familiar with Medicaid Redesign Team (MRT) initiatives (i.e. health homes, DSRIP).
  • Computer-literacy with knowledge of Microsoft Office applications.
  • Proficient in Microsoft Excel to sort, filter and enter data, and Access to manipulate data and create reports.
  • Strong analytical and technical skills.
  • Excellent communication, interpersonal and decision making skills.
  • Aptitude for using a fast-paced proactive vs. reactive approach to manage competing priorities.
  • Excellent time management and presentation skills.
  • Professional demeanor.
  • Ability to work independently and collaboratively.

Benefits
  • Vacation, personal, and sick leave
  • Medical, dental, vision plans
  • Pension & retirement plan
  • Short & long-term disability
  • Life insurance
  • AFLAC
  • Pet Insurance
  • Student Loan Forgiveness Programs
  • Public Service Loan Forgiveness
  • National Health Service Corp Loan Repayment

11th Hour Service is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will be considered for employment without regard to race, color, creed, religion, gender identity or expression, sexual orientation, national origin, disability, age, or veteran status.

Company Details

Falls Church, Virginia, United States
About 11th Hour Service 11th Hour Service was founded in 2006 by two Veterans, and alumni of Big 4 and large multinational consulting firms. Originally established as an executive head hunting and staffing firm – 11th Hour Search – our team developed a unique, proactive, and swift proprietary talent identification process rooted in excellence, but always grounded in quality, which is now known as...