Entitlement Medicaid Specialist

TITLE: Entitlement Medicaid Specialist (FT)

Reports to: Director of Entitlements

Location

219 East 121st St. New York, NY 10035

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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

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Major functions

Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office, Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and 820 programs.

Specific duties & responsibilities

• Conduct daily comprehensive review of consumers’ interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay
• Case conference difficult cases with the Director for guidance and support to ensure funding for 819 and Part 820 programs are obtained in a timely fashion
• Conduct interviews on new admissions for HRA/DSS/Medicaid/SSI/SSD/Self-Pay
• Expedite consumers with the selection of Managed Care Organization, assist with the NY State Market Place at point of admissions and upon Medicaid Eligibility
• Daily Data Entry of Medicaid Managed Care coverage / Medicare / Private Insurance / MAT in AWARDS, E-Lab and LabCorp Portal
• Daily update the Entitlement 820 Reports with consumers’ coverage
• Navigate Epaces (eMedNY) / Inovalon / STARS / SAAMS / AWARDS / WTW / Manage Care System Portals for coverage
• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, Medicare, and Private Insurance)
• Process Medicaid applications and recertifications for consumers through the Department of Social Services, NY State Exchange/Marketplace
• Investigate Medicaid disparities related to county / deferral / eligibility / denial / dropped / recertification
• Identify and process consumers with Medical / Pharmacy / Out-Patient restrictions through the Managed Care Organization and Managed Care System (MCS)
• Resolve problematic Medicaid Managed Care issues for Part 820 coverage
• Complete and submit bi-weekly 820 Medicaid Managed Care Reports
• Complete weekly Medicaid Manage Care Reports for five residential programs to reflect consumers’ coverage for the Pharmacy, Medical department and LabCorp
• Other relevant duties as assigned

Requirements

• BA Degree preferred
• Experience with Medicaid Managed Care; Human Services Field
• Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment
• Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking
• Notary Public Stamp

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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.