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Eligibility Operations

AHS partners with clients to achieve results that meet project requirements.

When a client elects to outsource their eligibility work, they need a contractor with much more than eligibility experience. The client needs a contractor with the proven characteristics and capabilities that contribute to a solid partnership, excellent operations and transparency to help implement monumental changes to their eligibility processing. We bring over a decade of expertise with relevant eligibility operations in multiple states for a variety of programs including CHIP, Medicaid and Exchange-related operations. Currently AHS performs Medicaid application intake and CHIP determination services for Tennessee, and formerly provided eligibility services for North Dakota and Wisconsin. We have also served related projects for the St. Louis Regional Health Commission and Cook County Health System.

We bring the proven capabilities that will meet client initial and emerging needs throughout the contract, including:

  • Flexibility to respond to changing business rules, legislative mandates and policy.
  • On-time coordinate implementations.
  • Understanding of diverse eligibility systems and workflows.
  • Expert data analysis and unprecedented levels of project reporting.

Our in-depth work demonstrates our competency with:

  • Performing back office and call center work with diverse populations and programs.
  • Preparing complex documentation, work streams and business rules.
  • Translating complex eligibility systems and requirements into robust operational protocols.
  • Translating diverse eligibility and application processing criteria into actionable data for a timely determination.
  • Implementing complex data transaction requirements.
  • Meeting the needs of various clients, stakeholders and partners.

“I love working for AHS because of the growth opportunity and the skill sets I’ve gained working on different projects.”

Damary Soto (IL)

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