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The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

Responsibilities:

Coordinates all Medicaid and Social Service Program benefits for plan members. Assures program eligibility criteria are met; required documentation is collected, reviewed, assessed, and submitted. Eligibility determinations, fair hearing and grievance options are explained to the member/designated representative. Monitors application recertification to ensure timely processing, and resolves all financial billing discrepancies to ensure the reduction of the capitation receivable. Assists members by coordinating Medicaid and Social Service-related benefits for active HomeFirst, FIDA and MAP members. Updates Market Prominence, Payor and other systems with member's documentation and changes. Provides answers to inquiries and follow-up information to the Member Services Department.

Qualifications:

• High School diploma or equivalent, required; Bachelor’s Degree, preferred
• 2-3 years prior experience in Managed Long Term Care(MLTCP) and Medicaid, preferred
• Bilingual preferred, verbal and written communication
• Working knowledge of various computer programs including Microsoft Word and Excel