Medicare & Medicaid Eligibility Specialist, Remote

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500™ list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com.

Role Overview:

As a Medicare/Medicaid Eligibility Specialist, you will advocate and assist low-income Medicare beneficiaries enrolled in a contracted health plan in the application and eventual requalification for government assistance programs.

This will require you to project empathy over the phone to gain the applicant’s trust and gain their consent for us to provide application assistance. You will then provide program qualifications and expertise to the applicant, manage outreach to government offices to the point of decision.

The person performing this role must have a strong working knowledge of program qualification requirements spanning 50 states, 3 territories and hundreds of counties specific to Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS) and the Medicare Savings Program (MSP).

Role Responsibilities:

• Conducts telephonic outreach activities for members who need to apply or recertify and are potentially eligible for various Medicaid programs including the Medicare Savings Programs.


• Collaborates with government offices to ensure accurate application and recertification process.


• Secures documentation for Medicaid/MSP renewal applications if needed for members.


• Attention to detail by adhering to state requirements and securing supporting documentation.


• Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation.


• Participates as required in operational development programs.


• Monitor research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicare programs and Medicaid Outreach Operations.


• Demonstrates behaviors, actions, and attitudes that reflect our vision, mission and values.


• Performs other duties as assigned.

Role Requirements:

• Medicare/Medicaid program experience, and experience with screening for Medicaid eligibility a strong plus


• Expertise and knowledge of Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS) and the Medicare Savings Program (MSP)


• Strong working knowledge with Microsoft Office programs, and some experience with Excel.


• Excellent oral communication skills; ability to communicate with elderly individuals and governmental personnel


• 2-3 years related experience with direct consumer interaction


• Outstanding customer service and communication skills


• Strong organizational, analytical, critical thinking and customer service skills


• Ability to analyze and interpret governmental program criteria


• Ability to manage a fast-paced environment


• Must be able to navigate through multiple databases/monitors with a minimum typing speed of 45 wpm


• Telephone experience and ability to interact and decipher information via telephonic or correspondence inquires


• Strong subject matter expertise of Medicaid programs regulations and industry standards


• Case management experience or related experience / intermediate


• A compassionate and empathetic nature with a strong desire to help and make a difference


• Bachelor’s or Associate’s Degree a plus

We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities. This position is bonus eligible in accordance with the terms of the Company’s plan. Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate. Centauri Health Solutions is an equal opportunity employer.