Medicaid/Medicare Services Specialist I

The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing programs, services and supports that protect and promote the health and well-being of all Kentuckians and their communities. The Department for Medicaid Services, Division of Program Integrity is responsible for guarding Medicaid against fraud, waste and abuse of program benefits by providers and members, and compliance with federal and state rules and regulations. The Medicaid/ Medicare Services Specialist I offers a wide-range of learning opportunities, including networking as this position will work closely with Providers, Managed Care Organizations, Management, and sister-agencies. Seeking a motivated person that will work in a high-volume contact center for the Department for Medicaid Services, Provider Enrollment where identifying customers' needs quickly, clarifying information, and researching every issue is required in order to provide resolutions to issues. To be successful, candidates should be professional, polite, and able to deal with difficult and stressful situations, and able to apply state and federal regulations in decision making. Learn more about us at: The Cabinet for Health and Family Services (CHFS) participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in U.S. CHFS will only use E-Verify once you have accepted a job offer and completed the Form I-9. For more information on E-Verify, or if you believe that CHFS has violated its E-Verify responsibilities, please contact Department of Homeland Security (DHS) at or Responsibilities and Duties: Provide specialized assistance to Medicaid providers, staff within the Department for Medicaid Services, and Medicaid Contractors. Respond to providers and Credentialing Agents inquiries on KY DMS Provider Enrollment eligibility, submission documents, and application status, as well as maintenance required on provider file. Collecting information about caller/provider, verifies in different information systems, and enters information into database. Entering information into CRM system to assist with call-tracking and quality assurance. Provides assistance to providers and government agencies through oral and written response to inquiries. Requires the ability to work independently and manage time effectively, as well as to work with difficult issues. Implements policy changes as appropriate. Performs research of state and federal statutes and regulations relative to provider enrollment and remains abreast of all changes to state and federal laws. Preferred Knowledge / Skills / Abilities: Strong ability in working with Medicaid Partner Portal Application, Medicaid Management Information System, and other provider enrollment research tools. Excellent verbal and written communication skills. Excellent computer skills, especially in Microsoft Office, with experience using Excel. Ability to work independently, with attention to detail; thoroughness and accuracy in completing tasks. Ability to apply state and federal regulations to work outcomes. Minimum Requirements EDUCATION: Graduate of a college or university with a bachelor's degree. EXPERIENCE, TRAINING, OR SKILLS: NONE Substitute EDUCATION for EXPERIENCE: NONE Substitute EXPERIENCE for EDUCATION: Experience in Medicaid and/or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development or human service or health care administration, insurance billing and/or claims will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year-for-year basis. SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE Working Conditions Incumbents working in this job title primarily perform duties in an office setting. Probationary Period This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111. If you have questions about this advertisement, please contact Tiffany Keffer at or .