New

Medicaid Eligibility Consultant III

UMass Med School

United States, Massachusetts, Westborough

Dec 09, 2025

Medicaid Eligibility Consultant III

Minimum Salary

US-MA-Westborough

Job Location

4 hours ago(12/8/2025 4:43 PM)

Requisition Number

2025-49063

# of Openings

Posted Date

Day

Shift

Exempt

Exempt/Non-Exempt Status

Non Union Position -W60- Non Unit Professional

Overview

Under the general direction of the Senior Associate or designee, the Medicaid Eligibility Consultant III will assist in the development, management, coordination and implementation of revenue initiatives for products and projects; both in and out of state. The Medicaid Eligibility Consultant III should be an insightful, detail-oriented professional with Medicaid-related experience, excellent analytical and organizing skills who is able to apply that skill set to support both Medicaid Eligibility and Program Integrity Initiatives as well as the design, development and implementation of Medicaid eligibility systems.

Responsibilities

Provide strategic oversight and lead the development, management, coordination and implementation of Medicaid eligibility and program integrity initiatives, in and out of state.

Serve as project lead in the analysis and evaluation of data to support Medicaid eligibility and program integrity cost savings projects in and out of state.

Lead in the research & development of new business opportunities.

Direct and manage assigned projects from start to finish.

Develop comprehensive work plans, define resource needs, and allocate tasks to support efficient project execution.

Provide strategic leadership in the development of Medicaid systems on behalf of the client Medicaid agency:

* Serve as Lead Subject Matter Expert (SME) in Medicaid eligibility regulations, operations, and processes to support the design, development, and implementation of changes to Medicaid MAGI and non-MAGI eligibility systems.

* Assist with and present Medicaid agency business needs and strategic vision in systems development activities and ensure they align with agency objectives.

* Actively participate in discussions in multi-agency workgroups supporting the development of a common eligibility application.

* Participate in meetings with the systems' upstream and downstream stakeholders to assess needs and provide solutions.

* Engage stakeholders to assess complex system needs and design integrated solutions that align with policy and operational goals

* Attend business and system design sessions;

* Review, provide feedback and approve appropriate business system design requirements;

* Attend regularly scheduled and ad hoc meetings virtually and onsite; and

Assist with testing and resolution of system defects.

Lead the development of agreements between public entities and the University.

Assist in the evaluation and respond to grant and business proposals by providing reporting and data analysis.

Develop and present success, merits of initiative to staff and clients.

Research and develops work plans to implement projects.

Coordinate with subcontractors to obtain data for various initiatives.

Qualifications

Master's Level Degree or equivalent in a business health policy, social service, or public administration related field

5-7 years experience in a related field
Extensive experience in interpreting State and Federal regulations as they apply to public assistance programs
Extensive and in-depth knowledge of Medicaid policies, programs and procedures and the ability to integrate this knowledge with new and existing IT systems.
Experience working with complex technical, systems and/or programs issues affecting Medicaid and its services to members.
Excellent verbal and written communication skills.
Project management skills and experience in implementing and project management of large projects
Demonstrated ability to work numerous projects simultaneously and meet deadlines Experience in supervision and/or demonstrate ability to manage and motivate staff
Expertise in Microsoft Word, Excel and PowerPoint and Access or SQL.
Ability to travel to the client and/or off- site locations weekly

Additional Information

Preferred Work Experience:

Strong quantitative and analytical skills
Ability to facilitate meetings and establish working relationships with various government and private contractors
Exceptional oral and written communication skills
Exceptional organizational skills
Team leadership skills

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