Summary
Location
Westborough
Type
full-time
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About this role
Under the general direction of the Senior Associate or designee, the Medicaid Eligibility Consultant II will assist in the development of contracts with state agencies; both in and out of state. The Medicaid Eligibility Consultant II should be an insightful, detail-oriented professional with Medicaid-related experience, excellent analytical and organizing skills who is able to apply that skill set to support both Medicaid Eligibility and Program Integrity Initiatives as well as the design, development and implementation of Medicaid eligibility systems.
Conduct complex analysis to support of Medicaid eligibility and program integrity projects in and out of state.
Perform research & development analysis relevant to Medicaid eligibility and/or program integrity revenue management/cost savings projects as assigned.
Contribute to the development of program and project expansion plans.
Contribute to the development of presentations and the preparation of marketing materials to clients.
Provide on-site support to senior staff during client visits and meetings
Participate in the development of agreements between public entities and the University.
Participate in the development of Medicaid systems on behalf of the client Medicaid agency:
- Serve as a Supporting Subject Matter Expert (SME) in Medicaid eligibility regulations, operations, and processes to support the design, development, and implementation of changes to Medicaid MAGI and non-MAGI eligibility systems.
- Assist with presenting Medicaid agency business needs and strategic vision in systems development activities and ensure they align with agency objectives.
- Participate in multi-agency workgroups supporting the development of a common eligibility application.
- Participate in meetings with the systems’ upstream and downstream stakeholders to assess needs and provide solutions.
- Attend business and system design sessions
- Review, provide feedback and approve appropriate business system design requirements
- Attend regularly scheduled and ad hoc meetings virtually and onsite; and
- Assist with testing and resolution of system defects.
Support procurement processes such as Request for Information (RFI) and Request for Proposal (RFP) development.
Contribute to project forecasting and complete assigned cost analysis tasks in support of financial planning and savings initiatives.
Participate in presentations to staff regarding success, merits of initiative, etc.
Independently research, develop, and prepare work and implementation plans in support of project and initiatives. Complete assigned projects from start to finish.
- Bachelor's Level Degree or equivalent in a business, health policy, social service, or public administration related field
- 3 to 5 years of experience in a business related field
- Extensive and in-depth knowledge of Medicaid policies, programs and procedures and the ability to integrate this knowledge with new and existing IT systems.
- Familiarity working with complex technical, systems and/or programs issues affecting Medicaid and its services to members.
- Strong verbal and written communication skills.
- Must have knowledge of state and federal regulations as they apply to public assistance programs
- Demonstrated experience in Microsoft Word, Excel and PowerPoint
- Demonstrated project management skills
- Ability to travel to the client and/or off- site locations weekly
Other facts
About University of Massachusetts Medical School
ForHealth Consulting partners with purposeful organizations, including state Medicaid agencies and health and human services organizations, to make the healthcare experience better for all – more equitable, effective, and accessible. We know that to do this, we need to address every aspect of the system – how we pay for it, how we manage information, and how we deliver quality care to everyone. As part of UMass Chan Medical School, we leverage world-class expertise to create transformational solutions across the health and human services system. ForHealth Consulting believes in the power of collaboration and a shared purpose – together, we can make healthcare better.
What you'll do
- The Medicaid Eligibility Consultant II will assist in the development of contracts with state agencies and conduct complex analysis to support Medicaid eligibility and program integrity projects. They will also participate in the development of Medicaid systems and provide support during client visits.
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