Medicaid Specialist

TITLE: Medicaid Specialist

REPORTS TO: Director of Entitlements

DEPARTMENT: Entitlements - 219 East 121st St. New York, NY 10035

Our Mission:

Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages—and across all five boroughs—beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.

If that sounds different than other treatment programs, you’re right. Because Odyssey is where recovery gets real.

In addition to competitive salaries, Odyssey House offers:

• A 35-hour work week (as opposed to a 40-hour work week)
• Vacation Plan and Holiday Schedule
• Life Insurance
• Medical Insurance (Two Plans)
• Dental and Vision Insurance
• Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
• Long-Term & Short-Term Disability
• Flexible Spending Account/Health Reimbursement Account
• 403(b) Plan
• Corporate Counseling Associates (CCA) EAP benefit
• Ability Assist Counseling Services (through The Hartford)
• Commuter Benefits
• Educational Assistance Programs
• Special shopping discounts through ADP Marketplace and PlumBenefits
• RUFit?! Fitness Program
• Legal Assistance through ARAG
• Optum Financial Service through ConnectYourCare
• Benefit Advocacy Center through Gallagher

MAJOR FUNCTIONS:

Maintain a working relationship with the Department of Social Services/Medicaid Office/Expedited and Marketplace to ensure Medicaid Managed Care guidelines and policies and procedures are follow.

SPECIFIC DUTIES & RESPONSIBILITIES:

• Conduct a comprehensive review to determine eligibility for Medicaid and Managed Care for the 820 Programs

• Daily Review of consumers’ insurance verification and Medicaid Managed Care coverage

• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare)

• Process Medicaid applications and recertifications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace

• Investigate Medicaid issues related to eligibility, deferrals, denials and recertifications

• Identify consumers with Medical and Pharmacy restrictions to complete MAP forms to the removal of restrictions

• Process restrictions through the Managed Care System (MCS), Office of the Medicaid Inspector General (OMIG)

• Resolve problematic Medicaid Managed Care and Department of Social Services issues

• Navigate eMedNY (ePACES) / Managed Care Portals / Inovalon / STARS / AWARDS

• Daily Data Entry of Medicaid Managed Care / Medicare / Private Insurance / MAT in AWARDS and E-Lab

• Prepare weekly status of consumers’ Medicaid Managed Care / Medicare / Private Insurance status and Expedite consumers with straight Medicaid coverage

• Review weekly consumers’ Medicaid Managed Care coverage and dropped coverage

• Prepare biweekly Medicaid Manage Care Reports to reflect current coverage

• Assist consumers with the selection of Managed Care and NY State Market Place

• Performs related or similar duties assigned by Director.

REQUIREMENTS:

• Associate/BA Degree preferred

• Experience with Medicaid and Managed Care and in Human Service Field

• Minimum 2 years of experience in Medicaid, managed care plans, application process, recertifications and regulations

• Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking

Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.