The agency may authorize the selected candidate to telecommute as a Hybrid. The agency may terminate or modify
the telecommuting arrangements at any time.
The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of
Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of
programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the
mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing
programs, services and supports that protect and promote the health and well-being of all Kentuckians and
their communities.
The Division of Health Plan Oversight is responsible for administering and overseeing key healthcare programs
that serve Kentuckians. The Division's responsibilities include Medicaid eligibility, oversight of Managed
Care Organizations (MCOs) through contract monitoring and compliance, appeal reviews, and administration of
the Kentucky Health Benefit Exchange.
This position is located within the Kentucky Health Benefit Exchange Branch, which oversees the operation and
management of Kentucky's State-Based Marketplace, kynect. As Kentucky's official health insurance marketplace,
kynect provides individuals and families with a single place to apply for health coverage, compare qualified
health plans, determine eligibility for financial assistance, and access programs such as Medicaid and the
Kentucky Children's Health Insurance Program (KCHIP). The Branch works to ensure Kentuckians have access to
affordable, high-quality health coverage and exceptional customer service.
The Medicaid/Medicare Services Specialist II position offers a rewarding opportunity to serve the citizens of
the Commonwealth while developing expertise in healthcare eligibility policy and program administration.
Employees in this position will have opportunities to participate in training, collaborate with internal and
external partners, and attend in-person events with kynectors and Managed Care Organizations to support
outreach and program initiatives.
Learn more about us at:
https://chfs.ky.gov/agencies/dms/pages/default.aspxResponsibilities and Duties:
- Assists customers with applications, eligibility determinations, renewals, and changes in circumstance for health coverage programs administered through kynect.
- Reviews and evaluates eligibility information to ensure accurate and timely determinations in accordance with state and federal laws, regulations, and policies.
- Researches complex eligibility and policy issues to identify appropriate resolutions and ensure compliance with established program requirements.
- Responds to customer, provider, stakeholder, and partner inquiries regarding eligibility, enrollment, and health benefit programs through multiple communication channels.
- Provides exceptional customer service while maintaining professionalism, confidentiality, and empathy when interacting with individuals experiencing difficult or stressful situations.
- Interprets and applies federal and state regulations, policies, and procedures to make sound eligibility and program decisions.
- Documents case actions, research findings, and customer interactions accurately and thoroughly within applicable eligibility and case management systems.
- Supports implementation of new policies, procedures, and initiatives related to the Kentucky Health Benefit Exchange.
Preferred Knowledge/Skills/Abilities:
- Knowledge of eligibility policies for Medicaid, Qualified Health Plans, and other health coverage programs.
- Ability to interpret and apply complex state and federal regulations.
- Strong analytical and problem-solving skills with attention to detail.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities in a fast-paced environment while meeting established deadlines.
- Experience providing high-quality customer service to diverse populations.
- Ability to de-escalate difficult customer interactions and resolve issues professionally.
- Proficiency using multiple computer systems and databases simultaneously.
- Ability to establish and maintain effective working relationships with internal and external partners.
- Excellent verbal and written communication skills.
- Excellent computer skills, especially in Microsoft Office, with experience using Excel.
- Ability to work independently, with attention to detail; thoroughness and accuracy in completing tasks.
- Ability to apply state and federal regulations to work outcomes.
The Cabinet for Health and Family Services (CHFS) participates in E-Verify and will provide the federal
government with your Form I-9 information to confirm that you are authorized to work in U.S. CHFS will only
use E-Verify once you have accepted a job offer and completed the Form I-9. For more information on E-Verify,
or if you believe that CHFS has violated its E-Verify responsibilities, please contact Department of Homeland
Security (DHS) at 888-897-7781 or
https://www.e-verify.gov/
