Medicaid Customer Service Representative

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Job description

Duration: 05 Months.

Location: Linthicum, MD

Job Summary:

Key Responsibilities

• Understand, and assure compliance to and adherence with, the Medicaid enrollment regulations, and related Maryland HealthChoice program policies and procedures related to Maryland HealthChoice member eligibility redetermination and renewals polices.

• Notify members, in accordance with Policies & Procedures (which reflect Maryland Medicaid HealthChoice and Maryland COMAR regulations) of their loss of eligibility.

• Ensure copies of notices and documentation are filed in Members' electronic records.

Responsibilities:

• Cultivate and maintain collaborative relationships - with primary care site partners, FQHC and community based outreach/enrollment organizations - to engage their assistance in working with members to maintain their Maryland Medicaid eligibility and correct information.

• Coordinate with Primary Care Sites when working with members on loss of Maryland Medicaid eligibility.

• Thoroughly log all member related interactions into Salesforce for the purpose of accurate tracking and analysis.

• Develop a process for effectively identifying members with issues and communicating resolution of the issue.

• Complete a Weekly Status Report for Supervisor and ABHMD Managers.

• Offer recommendations for improvements in ABHMD practices to enhance service delivery and member satisfaction.

• Participate in ABHMD sponsored meetings and events.

• Represent ABHMD in the community, when requested & provide other duties as assigned.

Experience:

• Associate's Degree or equivalent experience.
• Minimum Years' Experience Required 3-5 years
• BA/BS Degree preferred.
• 3+ years of healthcare experience
• 2+ years' experience specifically with Medicaid/Medicare program operations
• 1+ years' experience with Medicaid policy, financing, program operations, business requirement development, or systems
• Experience working with Medicaid eligibility requirements, as well as enrollment, renewal and redetermination related regulations and process.

Education:

• Associate's Degree or equivalent experience.

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