Eligibility and Enrollment Specialist

Description

At Healthy Alliance, our purpose is to improve health and empower communities facing barriers. Every community has its own needs, affecting the health of those who live, learn, work, and play within them. Our network brings together organizations, big and small, to coordinate and collaborate so that all communities have reliable access to the resources they need. Why? Because every New Yorker deserves the same opportunity to be healthy.

Designated as the Social Care Network (SCN) Lead Entity for the Capital Region, Central NY, and North Country under New York's 1115 Waiver Amendment's SCN & Health-Related Social Needs (HRSN) Program, we are responsible for ensuring that there is a seamless, consistent end-to-end process for screening, navigation, and the delivery of services – including food, housing, and transportation to thousands of Medicaid Members.

Transformative in nature, this novel Program will further sustain our vision of cultivating a world wherein everyone has a fair and just opportunity to be as healthy as possible.

As a  Albany Business Review's Best Places to Work and a  Modern Healthcare's Best Places to Work in Health Care award recipient, we strive to maintain a culture wherein high-performing, mission-driven team members collectively work toward better health for all. Dedicated to promoting a culture built upon autonomy, mastery, and purpose, we believe our differences in strengths and perspectives play an integral role in propelling us forward, while our core values ground us, serving as the common thread that unites our team.

We offer amenities, professional development opportunities, events, and programming that support the interests of our teams, while expanding and enriching our culture. Some of the benefits you can expect when you join Healthy Alliance include:

• Competitive compensation package
• Comprehensive insurance benefits available the 1st of the month after hire, including but not limited to medical, dental and vision, group short-term disability and life insurance with buy-up options, flexible spending and HSA company-contributed accounts, and more
• 401K with a company match
• Unlimited paid time off after 90 days of employment
• Company-sponsored training and certification opportunities
• Hybrid work environment and people-first workplace
• A workplace that values safety, respect, employee engagement, recognition, and diversity
• Salary range: $52,950-$60,892 per year, commensurate with experience

The Eligibility and Enrollment Specialist provides support to contracted partners, community members, providers, and managed care organizations (MCOs) throughout the eligibility process by answering questions and ensuring accurate information regarding eligibility and prior authorization requirements for timely service delivery. Through detailed understanding of program requirements and compassionate interaction with community members and their care team, this position will serve as a crucial link between health-related social need (HRSN) providers and the people they are designed to assist.

• Serve as the primary point of contact for internal teams, network providers, MCOs, Medicaid Members, and other external stakeholders for all enrollment, eligibility, and prior authorization activities and needs.
• Handle enrollment and eligibility phone calls and emails to answer questions, solve problems, and facilitate access to care for eligible Medicaid Members and their care teams.
• Validate Medicaid Member enrollment and eligibility through New York State Department of Health's (NYSDOH) Medicaid Eligibility Verification System (MEVS) and/or Electronic Provider Assisted Claim Entry System (ePACES)…