Healthy Alliance

Enrollment Specialist

• Serve as the primary point of contact for internal teams, network providers, MCOs, Medicaid Members, and external stakeholders regarding enrollment, eligibility, and prior authorization
• Handle enrollment and eligibility phone calls and emails
• Answer questions, solve problems, and facilitate access to care
• Validate Medicaid Member enrollment and eligibility through NYSDOH MEVS and/or ePACES
• Assign Members to established care team providers
• Verify and reconcile enrollment and eligibility file data
• Identify and resolve eligibility discrepancies
• Liaise with Operations, Finance, and MCOs to update eligibility discrepancies
• Manage enrollment and eligibility changes and communicate updates to relevant stakeholders
• Facilitate eligibility determinations for HRSN services using NYSDOH criteria
• Manage SCN-required prior authorizations for designated enhanced HRSN services
• Monitor enrollment and eligibility data to assign unassigned or disengaged community members for screening outreach
• Maintain accurate documentation before HRSN service provision
• Support Compliance reviews of service authorizations, post-service/pre-payment reviews, and appeals or service reconsiderations
• Escalate potential compliance risks to Performance Management and/or the VP of Compliance and Privacy

Explore Eligibility and Enrollment Specialist at Healthy Alliance. Review requirements and application details.