Medicaid Contracts Specialist/Med Only Team-162073, 165609, 165863

This series of positions determines eligibility for Health First Colorado (also known as Medicaid), including Long Term Care and CHP+. This position primarily works under a contract with a specified community partner and may be required to be onsite at various community partner locations. In addition to processing work under the contracts of Adams County, this position routinely processes general Health First Colorado/Medicaid work for Adams County.    

Med Contracts Specialist I: Responsible for processing Medicaid benefits and coordination with a community partner with supervisory support. 
Med Contracts Specialist II: Responsible for processing Medicaid benefits, including LTC, and independently training and coordinating with a community partner. 

 **Compensation is based on experience and qualifications***

• Examines applications to determine applicants/participants income, resources, household composition and employment status to assess their eligibility for medical assistance.
• Reviews applications for accuracy and completeness and makes requests for information regarding incomplete forms and missing documentation. Verifies required information by appropriate methods: e.g., phone calls to employers; applicants; computer database inquiries (interfaces); statistical reports from the State and/or change or status reports turned in by clients to determine program eligibility.
• Explains program eligibility requirements to applicants, including all rules and regulations, his/her rights and responsibilities, available benefit dates, reason for approval or denial and the right to appeal. 
• Interface daily with statewide computer system requiring accurate and complete data entry of information. Interprets and evaluates computer generated data to determine application to individual case processing for approvals, changes, denials, and discontinuations. 
• Utilizes computer daily for inquiry and data entry for preparation of complex correspondence, spreadsheet development and record maintenance and research. Maintain client records within the Colorado Benefit Management System (CBMS) and electronic case file in the Department's electronic document management system. Document all actions taken on applications and cases within CBMS. 
• Completes monthly reports that are instrumental in discovering discrepancies that could affect participant's eligibility. 
• Works closely with contracted community partner staff to share relevant information with the support of the supervisor.  
• Participates along with supervisor in the dispute resolution process with applicants/participants when requested. Prepares evidence, attends, and testifies in state level hearings on applicant/participant appeals.  
• Partners with supervisory support with service providers and other agencies to achieve positive outcomes for clients. 
• Performs other related duties and responsibilities as required. 

To be successful, our ideal candidate should have the following knowledge, skills, and abilities

• Knowledge of medical public assistance programs, as applicable. 
• Knowledge of CBMS. 
• Apply basic math and read, interpret, and apply rules and regulations. 
• Communicates clearly and concisely, both orally and in writing. 
• Differentiate between relevant and non-relevant information when making eligibility decisions. 
• Input data accurately and detect errors/make corrections. 
• Skills related to customer service. 
• Ability to establish, maintain, and foster positive and harmonious working relationships with those contacted in the course of work.

Med Contracts Specialist I: 

• Experience: This position requires at least one year experience in an entry level position determining eligibility in CBMS for Medicaid. 

Med Contracts Specialist II: 

• Experience: This position requires at least two years’ experience in a position determining eligibility in CBMS for Medicaid. 

Education and Training (All Levels): 

• High School Diploma or GED equivalent. 
• Satisfactory completion of an Associate's or bachelor’s degree in business, behavioral science, or another appropriately related field may substitute for experience on a year for year basis. 
• License or Certificate (All Levels): None. 
• Background Check (All Levels): Must pass a criminal background check.

Other (All Levels): 

• This position may require additional background or health requirements as determined by the contracted community partner. (For example, TB testing or a requirement for vaccination.)
• Bilingual applicants are preferred.
• Ability to work in a standard office environment.
• Ability to obtain, maintain, and ensure continued access to State and County systems in strict compliance with all applicable county and state regulations, policies, and user agreements.