Life at Healthy Alliance

At Healthy Alliance, our purpose is to improve health and empower the underserved. Every community has its own needs, affecting the health of those who live, learn, work, and play within them. Our network brings together organizations, big and small, to coordinate and collaborate so that all communities have reliable access to the resources they need. Why? Because every New Yorker deserves the same opportunity to be healthy. 

Designated as the Social Care Network (SCN) Lead Entity for the Capital Region, Central NY, and North Country under New York’s 1115 Waiver Amendment’s SCN & Health-Related Social Needs (HRSN) Program, we are responsible for ensuring that there is a seamless, consistent end-to-end process for HRSN screening, navigation, and the delivery of HRSN and other services to thousands of Medicaid Members. Transformative in nature, this novel Program will further sustain our mission of advancing health equity within and across historically marginalized communities.

As a 2019-2024 Albany Business Review’s Best Places to Work and a 2021-2024 Modern Healthcare’s Best Places to Work in Health Care award recipient, we strive to maintain a culture wherein high-performing, mission-driven team members collectively work toward better health for all. Dedicated to promoting a culture built upon autonomy, mastery, and purpose, we believe our differences in strengths and perspectives play an integral role in propelling us forward, while our core values ground us, serving as the common thread that unites our team.

Why You Should Join Healthy Alliance

We offer amenities, professional development opportunities, events, and programming that supports the interests of our teams, while expanding and enriching our culture. Some of the benefits you can expect when you join Healthy Alliance include:

• Competitive compensation package 
• Comprehensive insurance benefits available the 1st of the month after hire, including but not limited to medical, dental and vision, group short-term disability and life insurance with buy-up options, flexible spending and HSA company-contributed accounts, and more
• 401K with a company match
• Unlimited paid time off after 90 days of employment
• Company-sponsored training and certification opportunities
• Remote employer with flexible work schedules
• A workplace that values safety, respect, employee engagement, recognition, and diversity
• Salary range:  $51,650-$59,938 per year, commensurate with experience

Who You Are

The Eligibility and Enrollment Specialist provides support to contracted partners, community members, providers and managed care organizations (MCOs) throughout the eligibility process, by answering questions, and ensuring accurate information regarding eligibility and prior authorization requirements to ensure timely facilitation of service. Through detailed understanding of program requirements and compassionate interaction with community members and their care team, this position will serve as a crucial link between HRSN providers and the people they are designed to assist. 

**We are looking for someone in New York State's Capital, Central, or North Country regions**

What You’ll Do  

• Serves as the primary point of contact for internal teams, network providers, MCOs, Medicaid members, and other external stakeholders for all enrollment, eligibility and prior authorization activities and needs.  
• Handles enrollment and eligibility phone calls and emails to answer questions, solve problems and facilitate access to care for eligible Medicaid members and their care teams. 
• Validates Medicaid Member enrollment and eligibility through NYS DOH’s MEVS (Medicaid Eligibility Verification System) and/or ePACES (Electronic Provider Assisted Claim Entry System) to support screening, navigation, and enhanced HRSN services and assign Members to an established care team provider. 
• Ensures accurate enrollment and eligibility records through proactive verification and reconciliation of enrollment and eligibility file data, including identifying and resolving discrepancies. 
• Serves as the primary liaison between internal departments including Operations and Finance, and MCOs to ensure eligibility discrepancies are updated.  
• Manages changes to enrollment and eligibility, documenting and communicating updates to Social Care Navigators, enhanced HRSN Service Providers, MCOs and other SCNs to support care access and transitions of care.  
• Facilitates eligibility determinations for HRSN services based on established NYS DOH eligibility criteria, manages SCN required prior authorizations for designated enhanced HRSN services as per NYS DOH guidelines and SCN workflows. 
• Proactively monitors enrollment and eligibility data to assign unassigned and/or disengaged community members for screening outreach  
• Individual contributor to the success of key performance metrics.  
• Maintains accurate and up-to-date documentation of enrollment, eligibility and prior authorization information needed in advance of HRSN service provision. 
• Supports the Compliance team’s review and management of service authorizations, post service/pre-payment reviews and appeal/service reconsiderations from Medicaid members who have been denied assistance. 
• Escalates any potential compliance risks as appropriate to VP of Operations. 

This job description is not designed to cover or contain a comprehensive listing of task activities and/or duties that are required of the employee for this job. Responsibilities and activities may change at any time with or without notice.

What You’ll Need

Education  

• Relevant education and experience in areas of study including social or clinical work, health or social care program administration.  
• Coursework in communication, data management, and policy analysis is preferred.

Professional work experience  

• Experience dissecting legal and procedural documents to ensure assessments are accurate and in line with current policies. 
• Experience working with community members and care teams to determine eligibility and collaborating with care teams to obtain prior authorization for programs and services. 
• Experience applying federal, state, and local regulations to evaluate applications for Health-Related Social Needs (HRSN) services.  

Knowledge, Skills, and Abilities  

• In-depth knowledge of guidelines across federal, state, and local levels and ability to interpret and operationalize NYS DOH Guidelines for management of HRSN services. 
• Strong working knowledge of program eligibility criteria for successful enrollment of HRSN services 
• Demonstrated knowledge of policy changes and updates for accurate eligibility determination and program integrity maintenance. 
• Familiarity with social services or benefits administration  
• Through effective questioning and active listening, specialists gather crucial applicant information to determine program eligibility. 
• Strong experience and demonstrated excellence in customer service  
• Able to handle sensitive conversations with care, making applicants and care teams feel respected and understood. 
• Strong critical thinking, decision making, communication skills required  
• Ability to successfully manage challenging conversations  
• Ability to multi-task and prioritize work, data entry and attention to detail, strong documentation skills required 
• Ability to effectively work in a hybrid environment that requires primarily remote work with some office-based time    
• Experience with MS Office Suite, including Word, Excel, PowerPoint, Outlook, and Zoom/Teams 

Your next career opportunity is at Healthy Alliance!

Physical Requirements

This position involves sedentary work that primarily involves sitting/standing, use of typical office equipment such as a computer, laptop, and cell phone. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equal Opportunity Employer

Healthy Alliance is an Equal Opportunity Employer and does not discriminate against any employee or applicant on the basis of age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations and ordinances. We adhere to these principles in all aspects of employment, including recruitment, hiring, training, compensation, promotion, benefits, social and recreational programs, and discipline. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to hr@healthyalliance.org.

Privacy Requirement

This job function involves potential access/interaction with protected health information. Position will be required to abide by company policies and procedures that support federal, state, and local HIPAA regulations. Any violations will be subject to company policy which includes disciplinary actions up to and including separation of employment.

Healthy Alliance is an At-Will Employer.

If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to hr@healthyalliance.us

Healthy Alliance is an At-Will Employer.