MEDICAID ELIGIBILITY VERIFICATION SPECIALIST
Core
Review and analyze Medicaid case records and computer data to determine eligibility for State and Federal funding, identify retroactive obligations, and minimize audit disallowances.
Role type
Principal Administrative Associate II (Medicaid Eligibility Verification Specialist)
Builds
Categorical eligibility determinations for funding streams and Turnaround Documents (TADS) for demographic corrections
Domain
Public sector / Medicaid administration / Data verification
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medicaid policy interpretation, data analysis, case record review, fraud detection, report generation, system query testing, manual case lookup, documentation creation
Preferred skills
Knowledge of Welfare Management System (WMS), HRA One Viewer, SAVE, eMedNY, Paperless Office System (POS)
Technologies
Enterprise Data Warehouse (EDW), Medicaid Data Warehouse (MDW), Welfare Management System (WMS), HRA One Viewer, Systematic Alien Verification for Entitlements (SAVE), Electronic Medicaid of New York (eMedNY), Paperless Office System (POS)
Responsibilities
Review Medicaid case records to determine eligibility for funding; Prepare Turnaround Documents (TADS) for demographic changes; Verify invalid Social Security Numbers and prepare fraud referral reports; Perform quality assurance for data warehouse queries; Complete manual case lookups for press and senior staff requests; Analyze agency audit findings; Create case records using multiple government systems.
Seniority
Senior, hands-on IC