Blue Cross & Blue Shield of Rhode Island hiring Medicaid Eligibility Specialist in Providence, RI | LinkedIn (2024)

Please email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Schedule: Hybrid Compensation: $22.50 - $27.00/hr Jump into the new world of health insurance: At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.

Join others who know diversity is strength: We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.

Why this job matters: Coordinate and facilitate the Medicaid application and redetermination process to obtain or maintain Medicaid eligibility for members and prospective members entitled to Medicaid for the purpose of promoting enrollment and retention in the DSNP program.

What you will do:

• Conduct eligibility assessment of prospective members for Medicaid enrollment.
• Communicate Medicaid rules and regulations to members and prospective members.
• Serve as a liaison between prospective members and EOHHS (Medicaid).
• Assist existing members with Medicaid redetermination process by verifying members’ eligibility and by assisting with identification of necessary supporting documentation.
• Initiate and maintain proper follow-up with the member/prospective member and EOHHS caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
• Maintain a log of Medicaid eligibility and complete all re-determinations for members.
• Document progress notes to member/prospect file in SFDC.
• Participate in ongoing, comprehensive training programs as required.
• On occasion, perform home visits to complete all Medicaid applications on all new enrollees and re-determinations within a reasonable time frame.
• Field a variety of incoming member, sale representative and broker calls with a passion to deliver high quality service for our clients
• Tracking client inquires in BCBSRI internal system
• Perform other duties as assigned.

What you need to succeed:

• A combination of education and related work experience
• High school diploma or GED
• Two to four years of previous professional experience in a related position
• Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic.
• Working knowledge of Medicaid eligibility requirements, computer programs and software.
• Ability to communicate and present information to various levels of personnel.
• Computer navigation skills
• Written and verbal communications skills
• Time management skills
• Ability to collect and organize data
• Ability to work independently
• Ability to meet established time and quality standards
• Ability to exercise sound judgment

The extras:

• Four or more years experience in a customer service environment
• Associate’s degree
• Bi-lingual skills
• RI Producers License
• Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc

Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week*.
• Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.

The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

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