Medicaid Eligibility Specialist II (Remote)

Medicaid Eligibility Specialist II (Remote)

• Are you an experienced Medicaid Eligibility Specialist II looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

The Medicaid Eligibility Specialist II is responsible for supporting the Alabama Medicaid contract by answering incoming telephone calls. Resolving customer questions and complaints and requests. Adhering to internal policies and procedures. Utilizing working knowledge of the organization’s services to meet productivity and quality standards. This is a remote position, open to candidates living anywhere.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Review the recipient’s completed application and supporting documentation.
• Perform and document outreach activities for the Agency’s to those in an ABD PHE extension.
• Make recommendations for the beneficiary ‘s eligibility determination to designated Program staff concerning final disposition.
• Assist with obtaining and filing initial application for ABD Programs
• Assist with updating contact information.
• Refer beneficiaries to Waiver Administering Agencies when appropriate.
• Secure documentation and verifications needed to determine Medicaid eligibility.
• Make recommendations to the Agency upon final disposition of applications.

• Investigates and resolves or reports customer problems. Identifies and escalates difficult situations to the appropriate party.
• Meets or exceeds standards for call volume and service level per department guidelines.
• Initiates files by collecting and entering demographic, provider, and procedure information into the system.
• Serves as liaison between the Call Center Supervisor and Customer Service Representatives.
• Serves as a subject matter expert for all related processes and customer service workflows.
• Serves as a mentor/preceptor for new employees during the orientation period.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

What you’ll need:

Required Qualifications

• Requires High School Diploma or equivalent; (Associates or Bachelor’s Degree in Human Services Field preferred). –
• Medical terminology course(s) helpful.

Knowledge, Skills, Abilities

• Knowledge of:

o Medical terminology

o Health insurance industry

• Ability to:

o Speak English fluently enough to be clearly understood over the telephone.

o Use phone system effectively.

o Research and investigate.

o Follow confidentiality policies and procedures.

o Navigate and use electronic equipment and systems easily and proficiently.

o Multitask on a personal computer while conducting telephone conversations.

o Work in a fast-paced call center environment

o Remain calm and courteous when handling difficult calls and request

• Skills:

o Effective verbal and listening skills to provide courteous and professional customer service.

o Effective PC skills including electronic mail, intranet and industry standard applications.

Experience

• 2+ year’s customer service/telephone experience in a similar call center environment and/or industry.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.