Job: Medicaid Specialist
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This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a Regional Office or Central Enrollment Office.
Examples of Work:
Examples of work performed in this classification include, but are not limited to, the following:
Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region.
Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.
Determines an applicant's eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants' applications.
Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory.
Verifies accuracy of information listed on applicants' applications including income, bank accounts, and any other assets.
Makes determination of an applicant's eligibility based upon established criteria.
Visits contact centers and medical facilities; assists other Regional Offices on an as-needed basis.
Performs related or similar duties as required or assigned.
These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate's ability to perform all essential functions of the position.
A Bachelor's Degree from an accredited four-year college or university.
An Associate's Degree or completion of sixty (60) semester hours from an accredited college or university;
Two (2) years of experience related to the described duties.
Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:
1. Maintains caseload for Medicaid eligibility.
2. Maintains good public relations and customer service.
3. Collects eligibility data information.
4. Visits Medicaid contact centers and/or long-term care facilities.
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