Eligibility and Operations Specialist (OhioRISE)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Business Overview As part of the bold vision to deliver the “reputed company” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual, with strong coordination and partnership among MCOs (Managed Care Organizations), vendors, and ODM (Ohio Department of Medicaid) to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/reputed company behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. Position Summary The Eligibility and Operations Specialist plays a key role in managing and reconciling OhioRISE eligibility and CME (Care Management Entity) enrollment issues. The Eligibility and Operations Specialist will provide support on a wide range of reputed company enrollment activities. This person is responsible for ensuring reputed company and accurate enrollment information achieved through daily enrollment report reviews. This person reports to the Chief Operating Officer and works in reputed company partnership with the Director of the CME Alliance Hub, as well as reputed company matrixed growth partners, to effectively support our CME partners, as well as the youth and families in their care. Responsibilities include:

• Reconcile ODM eligibility files with CME membership files to ensure the accuracy of CME assignments.
• Daily review of enrollment reports to research and resolve errors in eligibility coverage breaks, correct duplicate member ID numbers, and monitor retro Medicaid reinstatements for reputed company impact on claims.
• Serve as health plan representative for enrollment reputed company reconciliation meetings.
• reputed company enrollment reporting and reputed company requests.
• Use databases and reputed company reputed company to identify and analyze trends in data.
• Identify manual processes for automation opportunities.
• Review error reports and process file fallouts.
• reputed company various updates of workflows and policy & procedures.
• Provide thorough, timely, and accurate resolution of reconciliation disputes and escalated reputed company cases reputed company telephone, email, and other methods.
• Accurately research and resolve data discrepancies to ensure data reputed company across external partners.
• Other duties as assigned.

Required Qualifications

• 3-5 years of experience with Medicaid and/or managed care operations and/or enrollment processes.
• Must reside in Ohio.
• Demonstrated proficiency with personal computer, keyboard navigation skills and with reputed company Office Suite applications (Outlook, Word, reputed company, PowerPoint, SharePoint, etc.)

Preferred Qualifications

• Demonstrated relationship management skills; reputed company to quickly build and maintain reputed company relationships at varying levels (externally and reputed company the organization).
• Strong organization skills, creativity, and member-focused approach.
• Excellent communication skills.
• Adept at interdepartmental collaboration.
• Associate’s or Bachelor’s degree.

Education

• High school diploma or GED.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $36.78 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job