Eligibility Specialist II (NEMT and MCC)

•  Thorough knowledge of Medicaid eligibility policies, procedures, and Non-Emergency Medicaid Transportation (NEMT) program requirements.
• Considerable knowledge of call center operations, customer service practices, and systems used to manage eligibility and transportation requests (e.g., NC FAST or similar platforms). 
• Ability to serve as a technical resource to Eligibility Specialist I staff by interpreting policies, resolving procedural questions, and providing guidance on eligibility determinations and transportation services. 
• Ability to review and process transportation requests, verify eligibility, and ensure accuracy and completeness in accordance with established guidelines.
• Ability to assist with escalated customer concerns by applying sound judgment, clarifying policies, and ensuring appropriate resolution in a professional manner. 
• Strong organizational and analytical skills to support workflow coordination, monitor pending work, identify delays or barriers, and assist in maintaining efficient unit operations. 
• Ability to support quality assurance efforts by reviewing work for accuracy, reinforcing compliance with policies, and assisting with audit and documentation requirements. 
• Ability to compile, track, and maintain reports, spreadsheets, and other operational data to support productivity monitoring and management review. 
• Ability to assist with onboarding and training of new staff by reinforcing procedures, systems usage, and customer service expectations. 
• Strong communication skills, including the ability to effectively interact with clients, transportation vendors, medical providers, community partners, and internal staff. 
• Ability to maintain confidentiality and handle sensitive information in compliance with all regulatory requirements. 
• Ability to adapt to changing policies, priorities, and workload demands while maintaining accuracy, efficiency, and professionalism. 
• Ability to establish and maintain effective working relationships and contribute to a collaborative team environment.
  

• Review and process Non-Emergency Medicaid Transportation (NEMT) requests, including verifying Medicaid eligibility and conducting required consumer assessments. 
• Coordinate transportation services by authorizing trips, ensuring timely scheduling, and communicating with transportation vendors to support continuity of care. 
• Assist with Medicaid Call Center operations by responding to inquiries, addressing escalated customer concerns, and ensuring accurate interpretation of policies and procedures. 
• Provide technical guidance and support to Eligibility Specialist I staff by answering policy-related questions and assisting with complex or non-routine cases. 
• Monitor and support daily workflow by tracking pending work, identifying delays or barriers, and assisting with unit coverage as needed. 
• Prepare, maintain, and track reports related to unit productivity, performance metrics, and operational activities. 
• Assist with quality assurance efforts by reviewing work for accuracy, completeness, and compliance with established policies and procedures.
• Support audit and management review activities by preparing and maintaining required documentation, reports, and spreadsheets. 
• Assist with onboarding and training of new staff, reinforcing standard operating procedures, systems usage, and customer service expectations.
• Communicate effectively with clients, medical providers, transportation vendors, community partners, and internal staff to resolve issues and ensure efficient service delivery. 
• Maintain confidentiality and professionalism when handling sensitive client and program information in accordance with all regulatory requirements.
• Support day-to-day unit operations and perform related duties as assigned to ensure efficient and effective service delivery. 
• Determine Medicaid eligibility. 
• Must be adaptable and flexible while providing exceptional internal and external customer service.
  

Salary : $40,914 - $47,050