Eligibility Specialist II (NEMT and MCC)

About the Department

The Eligibility Specialist II provides advanced support to the Non-Emergency Medicaid Transportation (NEMT) and Medicaid Call Center (MCC) units by assisting staff and supervision with workflow coordination, policy guidance, and administrative tasks.

The role assists leadership and staff to ensure daily operations are efficient, accurate, and compliant, supporting the delivery of services to clients and contributing to smooth unit operations.

Position Duties

A successful candidate should have the following knowledge, skills, and abilities:

•  Thorough knowledge of Medicaid eligibility policies, procedures, and Non-Emergency Medicaid Transportation (NEMT) program requirements.
• Considerable knowledge of call center operations, customer service practices, and systems used to manage eligibility and transportation requests (e.g., NC FAST or similar platforms). 
• Ability to serve as a technical resource to Eligibility Specialist I staff by interpreting policies, resolving procedural questions, and providing guidance on eligibility determinations and transportation services. 
• Ability to review and process transportation requests, verify eligibility, and ensure accuracy and completeness in accordance with established guidelines.
• Ability to assist with escalated customer concerns by applying sound judgment, clarifying policies, and ensuring appropriate resolution in a professional manner. 
• Strong organizational and analytical skills to support workflow coordination, monitor pending work, identify delays or barriers, and assist in maintaining efficient unit operations. 
• Ability to support quality assurance efforts by reviewing work for accuracy, reinforcing compliance with policies, and assisting with audit and documentation requirements. 
• Ability to compile, track, and maintain reports, spreadsheets, and other operational data to support productivity monitoring and management review. 
• Ability to assist with onboarding and training of new staff by reinforcing procedures, systems usage, and customer service expectations. 
• Strong communication skills, including the ability to effectively interact with clients, transportation vendors, medical providers, community partners, and internal staff. 
• Ability to maintain confidentiality and handle sensitive information in compliance with all regulatory requirements. 
• Ability to adapt to changing policies, priorities, and workload demands while maintaining accuracy, efficiency, and professionalism. 
• Ability to establish and maintain effective working relationships and contribute to a collaborative team environment.
  

Minimum Qualifications

High school graduation or GED is required, along with three years of paraprofessional, clerical, or public contact experience involving interviewing, negotiating, explaining information, gathering and analyzing data, or performing mathematical or legal tasks.

One year of experience in an income maintenance program may substitute for up to two years of the required experience.

Other Qualifications

Essential duties and responsibilities include but are not limited to:

• Review and process Non-Emergency Medicaid Transportation (NEMT) requests, including verifying Medicaid eligibility and conducting required consumer assessments. 
• Coordinate transportation services by authorizing trips, ensuring timely scheduling, and communicating with transportation vendors to support continuity of care. 
• Assist with Medicaid Call Center operations by responding to inquiries, addressing escalated customer concerns, and ensuring accurate interpretation of policies and procedures. 
• Provide technical guidance and support to Eligibility Specialist I staff by answering policy-related questions and assisting with complex or non-routine cases. 
• Monitor and support daily workflow by tracking pending work, identifying delays or barriers, and assisting with unit coverage as needed. 
• Prepare, maintain, and track reports related to unit productivity, performance metrics, and operational activities. 
• Assist with quality assurance efforts by reviewing work for accuracy, completeness, and compliance with established policies and procedures.
• Support audit and management review activities by preparing and maintaining required documentation, reports, and spreadsheets. 
• Assist with onboarding and training of new staff, reinforcing standard operating procedures, systems usage, and customer service expectations.
• Communicate effectively with clients, medical providers, transportation vendors, community partners, and internal staff to resolve issues and ensure efficient service delivery. 
• Maintain confidentiality and professionalism when handling sensitive client and program information in accordance with all regulatory requirements.
• Support day-to-day unit operations and perform related duties as assigned to ensure efficient and effective service delivery. 
• Determine Medicaid eligibility. 
• Must be adaptable and flexible while providing exceptional internal and external customer service.