Job Posting for Medicaid Eligibility Policy Consultant at North Carolina Dept of Health and Human Services

Description of Work

**This position is exempt from the State Human Resources Act**

This position is now reposted. Previous applicants must reapply for consideration.

TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.

This position is home-based, and staff are expected to attend in-person meetings in Durham, NC, quarterly and at other times as determined by management.

Position Summary

Member Operations manages the policy development process for eligible recipients and enrollment of beneficiaries for Medicaid, business requirement development and the beneficiary and county experience improvement strategy for NC FAST, our beneficiary eligibility and enrollment technology platform. Member Operations staff serve as the business leads for new capability development, business requirements, trainings, and communications to the Divisions and external stakeholders; the relationship with the NC Department of Social Services (NC DSS), local county Departments of Social Services (DSSs), and the field staff team that oversees the county level enrollment process to foster compliance and quality in eligibility determinations and redeterminations; policy expertise, design, and implementation of eligibility changes required for the transition to Medicaid managed care, including Standard Plans, Tribal Option, Tailored Plans, and Foster Care plans, and eventually the transition of our LTSS and dually eligible populations.

The Medicaid Eligibility Policy Consultant, classified as a Human Services Program Consultant I, reports to the Medicaid Eligibility Policy Supervisor. This position researches, writes, and interprets Medicaid eligibility policy for the multiple Medicaid programs under Title XIX and Title XXI.

Job Specific Responsibilities

Develop Medicaid eligibility policy as assigned and assure proper legal and regulatory basis for the policy.
Identify all statutory, regulatory and policy sources that pertain to the assignment.
Read, analyze and identify policy impacts and questions that need to be answered from what sources (CMS, Federal Registries, etc.).
Determine the need for and prepare State Plan Amendments (SPAs) and fiscal impact statements as needed.
Work with NC FAST to identify business rules that impact the eligibility system and require updates.
Write impact statements when the General Assembly requests a proposed change to existing policy or adding or removing Medicaid coverage groups.
Complete applications monitoring for assigned counties as they relate to beneficiary eligibility.
Review approvals, denials, withdrawals and inquiries to determine compliance with the application processing standards.
Identify inconsistencies in the application of policy or systems issues based on the nature and frequency of questions. (State-wide or county specific issues).
Review appeals decisions made by the state hearing officers and Medicaid Quality Assurance to assure correct policy is applied.

Applicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.

About NC Medicaid (Division of Health Benefits)

The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.

Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.

Knowledge, Skills and Abilities / Competencies

To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

Proven ability in establishing and maintaining effective working relationships.
Excellent oral and written communication skills.
Strong attention to detail and organizational skills to ensure independent follow up using research and analysis.
Demonstrated experience in eligibility determination and/or investigation in Medicaid or Food Stamp programs.
Demonstrated ability to read and analyze complex legal and regulatory documents to understand the requirements, develop written policy, and identify issues that may need to be resolved.

Management Preferences:

Previous and proven work experience at Division of Health Benefits/NC Medicaid.
Familiarity with relevant and current NC Medicaid operations.
Proven consultative experience in the area of Medicaid eligibility determination.
Proven work experience using NCFAST.

Minimum Education and Experience Requirements

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for details.

Master's degree in a discipline relative to the program from an appropriately accredited institution and two years of related experience; or

Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and four years of related experience; or

an equivalent combination of education and experience.

Degrees must be from appropriately accredited colleges or universities.

Supplemental and Contact Information

The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.

Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

To be under consideration for this vacancy, all applicants must complete an online application using this link: https://www.governmentjobs.com/careers/northcarolina. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.

Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.

For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. Applicants will be communicated with via email only for updates on the status of their application. If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov.

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Medicaid Eligibility Policy Consultant

Job Posting for Medicaid Eligibility Policy Consultant at North Carolina Dept of Health and Human Services

Description of Work

Knowledge, Skills and Abilities / Competencies

Minimum Education and Experience Requirements

Supplemental and Contact Information

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