Medicaid Specialist

Job Description

Job Description

The Medicaid Specialist is responsible for the timely and accurate completion and review of Medicaid Pending applications to ensure all required documentation is made available and gathered for timely processing to the County. Further is responsible to ensure that policy and procedures in the business office are followed in accordance with current applicable Federal, State and local standards, guidelines and regulations. Ensures that all information uploaded into the billing software is accurate and completed promptly.

CSSCM is looking for an on-site, full time Medicaid Specialist to be a part of our great team. We are a forward thinking, progressive care management company that specializes in medically complex cases.

Responsibilities

• Works one on one with clients, responsible parties, and families to ensure the Medicaid Application process starts within 24-48 hours of admission for any admission that will become Medicaid Pending.

• Educates clients, responsible parties, families in the Medicaid Process and communicates documents required to complete the Medicaid Application.

• Informs Business Office Manager promptly if there is no cooperation or a delay in cooperation from a client, responsible party, family in the Medicaid Application Process.

• Ensures complete confidentiality of financial, HIPAA protected information of clients.

• Responsible for the completion of the Options package for Aging and Adult Services for the clinical approval of Medicaid.

• Responsible for ensuring Spousal cases include the additional information required by the County to ensure a timely processes and approval of a Medicaid Application.

• Responsible to ensure the resident and or responsible party or family member understands and signs the Patient Liability which is due on a monthly basis.

• Responsible to keep and update the Medicaid Pending log on a daily basis.

• Works collaboratively with the applicable County office to ensure they have all required documentation.

• Responsible to attend face to face interviews at the County Assistance Office in order to secure a grant if families are uncooperative or unable to attend.

• Responsible for ensuring the County Assistance Office is in receipt of all verifications.

• Responsible for ALL active in-house Medicaid clients’s yearly recertifications.

• Comply with Health Insurance Portability and Accountability Act (HIPAA) regulations.

Qualifications

• Must have ten plus years of work experience in Long Term Care. Proficient in the ICP Medicaid application process.

• Must be efficient, maintain confidentiality, exhibit good judgment, and have the ability to speak and write effectively.

• Must possess good communication and people skills.

• Must be knowledgeable of all Medicaid legal regulations, guidelines and best practices.

• Must understand the basics of working in the business office and importance of following established processes.

• Must possess an aptitude for problem solving.

• Employment is contingent on completion of all pre-employment screenings inclusive of criminal background check and Medicaid Exclusion Screening, both indicating negative results.