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Healthy AlliancePosted 10/20/2026full-timeSchenectady • New York • United StatesMid-LevelSenior💰 $52,950 - $60,892 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing enrollment and eligibility processes, including validating Medicaid Member enrollment and facilitating access to care. Proficient in interpreting NYSDOH guidelines and ensuring compliance with federal and state regulations.
Highest-signal resume keywords
Enrollment And Eligibility ManagementKnowledge Of NYSDOH GuidelinesExperience With Managed Care OrganizationsStrong Customer Service SkillsCritical Thinking And Decision-Making
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- High school diploma or equivalent
- Postsecondary education in Social Work, Human Services, Public Health, Healthcare Administration, or a related field preferred
- Equivalent combination of education and experience will be considered
- Coursework in communication, data management, and policy analysis preferred
- Experience with Managed Care Organizations (MCOs) and/or case management preferred
- Familiarity with social services, public benefits, or healthcare programs preferred
- In-depth knowledge of federal, state, and local guidelines and ability to interpret and operationalize NYSDOH guidelines for HRSN services
- Strong working knowledge of program eligibility criteria
- Knowledge of policy changes and updates for eligibility determination and program integrity
- Ability to manage high-volume workload, review complex cases, and make eligibility-based decisions
- Familiarity with social services or benefits administration
- Effective questioning and active listening
- Strong customer service experience
- Ability to handle sensitive conversations with care
- Strong critical thinking, decision-making, communication, and documentation skills
- Ability to contribute to key performance metrics
- Ability to manage challenging conversations
- Ability to multitask, prioritize work, perform data entry, and maintain attention to detail
- Ability to work in a hybrid environment requiring primarily remote work with some office-based time
- Experience with MS Office Suite, including Word, Excel, PowerPoint, Outlook, and Zoom/Teams
- Ability to work according to Healthy Alliance core competencies and values
- Must comply with applicable HIPAA-related company policies and procedures
Benefits
Comp & perks- Comprehensive insurance benefits available the 1st of the month after hire, including medical, dental and vision
- Group short-term disability and life insurance with buy-up options
- Flexible spending and HSA company-contributed accounts
- 401K with a company match
- Unlimited paid time off after 90 days of employment
- Company-sponsored training and certification opportunities
- Hybrid work environment
- Professional development opportunities, amenities, events, and programming
- Workplace focused on safety, respect, employee engagement, recognition, and diversity
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data ManagementEligibility DeterminationPolicy AnalysisCase ManagementDocumentation Skills
Soft Skills
Effective QuestioningActive ListeningCommunication SkillsAbility To Handle Sensitive ConversationsMultitasking And Prioritization
Tools & Technologies
MS Office SuiteZoomTeams
Industry Keywords
MedicaidSocial ServicesPublic BenefitsHealthcare ProgramsCompliance