Program Specialist Member Services
Central California Alliance for Health - Scotts Valley, CA

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(Scotts Valley)

Under the direction of the Resolution Unit Manager, the Program Specialist is responsible for the review of and response to support calls escalated by internal staff, external agencies and/or sub-contractors including the Social Security Administration (SSA), the State Department of Health Care Services (DHCS), the State Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB) and various departments within Merced, Monterey and Santa Cruz counties. The Program Specialist is responsible for testing and maintaining the Alliance Information System (AIS) Member Eligibility Verification systems available through the Alliance's Knox Keens transfers, beneficiary relocations outside of Alliance service areas, long term care facility placements, Public Guardian and/or other conservator issues and Foster Care placements. The Program Specialist reviews exception reports generated from daily eligibility loads and researches and resolves discrepancies with relevant entities. Researches and resolves eligibility and coverage issues relating to plan transfers.

The position requires an AA degree and three (3) years of experience in Public Assistance, Health Care or Human Services programs which must have included work with Management Information Systems, data entry, spreadsheet, word processing programs and training others or an equivalent combination of education and experience. Also requires experience with the California Medic-Cal program, Medi-Cal eligibility and the Medi-Cal Eligibility Data System (MEDS) and experience with Alliance Know-Keene health plans and programs and the automated eligibility verification systems available through those lines of business. Experience with a PC-based eligibility data system is strongly preferred. Must be proficient with personal computers and report-generating, eligibility, word processing and spreadsheet software; MS Word, Excel, Oracle required.

For a complete Position Description, click here .

This is an Exempt position.

No telephone calls please.

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