Senior Healthcare Program Specialist - Medicare Savings Program and Recoveries

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve. Senior Healthcare Program Specialist (Level 2 or 3) - Albany, NY Division of Eligibility & Marketplace Integration (DEMI) Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries Telecommuting Option: This position is eligible for 50–100% telecommuting. Consideration for 100% remote work may be given based on the candidate’s home location and alignment with business needs. Duties: In this position within the Third-Party Liability (TPL) Unit, an individual will be able to perform the following duties to be successful in the position:

• Work independently to review information submitted relative to Third Party Health Insurance (TPHI) and make the necessary determination regarding when and how to update eligibility and claims systems.
• Take the appropriate actions regarding Medicaid enrollment and premium reimbursement.
• Demonstrate systems processes for new employees and review their task progress.
• Review and update records based on reports or information which may be received from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others.
• Ability to problem solve complex cases.
• Ability to track, update and create reports from departmental data.
• Create and maintain spreadsheets used for tracking data and identifying work to be processed.
• Calculate monthly unit statistics and provide to operations management for inclusion on routine production reports.
• Oversee the work processes and assist with work-related questions or issues.
• Review and apply Medicaid Policy and identify issues with process where adherence to policy may need review.
• Document and assist with review of procedures as well as answer questions for coworkers, management, or other stakeholders regarding applying policy to Third Party Liability (TPL) processes.
• Run simple Medicaid Data Warehouse (MDW) queries to assist with TPL data needs.
• Create and maintain procedural documents.
• Review, interpret, and understand policy, regulations, and legislation as it applies to Medicaid and Department of Health processes.

Basic Qualifications:

• Bachelor's Degree,
• 8 years experience in healthcare field

Desired Characteristics:

• Experience with customer service using both oral and written communication. Experience with Data Entry in the Medical Insurance industry.
• Experience utilizing spreadsheets (Excel), other forms of database tools and word documents (MS Word).
• Strong attention to detail with the ability to review data thoroughly. Demonstrated ability to review, interpret, and understand policy, regulations, and legislation as it applies to Medicaid and Department of Health processes.
• Ability to work individually and as part of a dynamic team. Demonstrate flexibility and ability to work in fast paced environment. Leadership and teambuilding experience is a plus.

Technology Requirements for Employment: To ensure a smooth and productive remote work experience, all candidates must meet the following technology requirements:

• Personal Equipment: Candidates are required to use their own computer and electronic equipment. The company does not provide technology equipment upon employment.
• Internet Connectivity: A reliable, high-speed internet connection is essential. Candidates must have access to their own wireless internet (WiFi) to support consistent and secure connectivity.
• System Functionality: The computer must be fully functional and capable of supporting all necessary work-related applications and communication tools.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role. Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship including H-1B sponsorship) by SSO. Under the federal laws relating to the F-1 STEM EAD program, SSO may be able to support a STEM EAD extension application at the sole discretion of your Designated School Official. This does not guarantee that any STEM EAD extension application will be approved. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant. Apply tot his job Apply To this Job