Entitlement Medicaid Specialist na Odyssey House

TITLE: Entitlement Medicaid Specialist (Part - Time)

REPORTS TO:  Director of Entitlements                                                             

LOCATION: 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 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 Part 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/SSI/SSD/Self-Pay
• Expedite consumers with the selection of Managed Care Organization and NY State Market Place at point of admissions and upon Medicaid Eligibility
• Daily Data Entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab
• Navigate Inovalon / eMedNY (Epaces) / STARS / SAAMS / AWARDS / 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 issues related to County/deferral/eligibility/denials/dropped/ recertifications
• Identify consumers with Medical/Pharmacy/Out-Patient restrictions to complete MAP forms for the removal of restrictions
• Process enrollment/disenrollments MAP forms through the Managed Care System (MCS) and to the Medicaid Inspector General OMIG
• Resolve problematic Medicaid Managed Care issues for Part 820 coverage
• Daily update the Entitlement 820 Reports with consumers’ Medicaid (Fee-For-Service) / Expedited /Managed Care/Medicare/Private Insurance/Undocumented
• Complete and submit bi-weekly 820 Medicaid Managed Care Reports
• Submit weekly Medicaid Manage Care Reports to reflect consumers’ coverage for 5 Residential Programs to the Pharmacy, Medical and LabCorp
• Performs related or similar duties assigned by Director.

REQUIREMENTS:  

• High School / associate degree
• Experience with Medicaid Managed Care and Human Service 
• Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment
• Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking skills

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.