What are the responsibilities and job description for the Medicaid Liaison position at Abbott House?
JOB SUMMARY
The Medicaid Managed Care Liaison is the primary contact person for the Medicaid Managed Care Plans (MMCP). MMC Liaison must have experience, expertise, and knowledge of:
The child welfare system
Foster care healthcare requirements
The unique complex needs of the foster care population
Medicaid Managed Care policies and procedure
The Medicaid Managed Care Liaison is a full-time position.
GENERAL RESPONSIBILITIES
29I Core Services
- Coordinate with MCO (Managed Care Organization) Foster Care Liaison
- Inform and coordinate PCP (Primary Care Physician) changes
- Assist with plan enrollment, disenrollment, and transitions
- Issue plan Welcome letters
- Secure plan ID showing effective date
- Assist in ID card replacement
- Assist with foster care placement changes including: - Access to health care - Facilitate a single case agreement when a child is placed outside of the MMCPs service area or provider network
- Interact with clinical and billing staff
- Refer children for needed services and assist in provider selection
- Coordinate with health care providers, including school and community-based services
- Maintain eligibility for public or private health insurance
- Assist with consent and/or confidentiality issues
- Obtain authorizations from all MCO
- Update the AccuMedic (EHR) system with the authorization information to ensure proper billing occurs
Health Services Supervisor
- Take care of general office duties such as answering telephone and triaging calls, maintaining office supplies, preparing time sheets, and maintaining clinical staff schedules in Microsoft Outlook.
- Assist Foster Care and Group Home programs with Access to care.
- Oversee and support program audits
- Responsible for closed medical records
- Arrange Single Case Agreements with out of network placements
- Billing and Clinical Staff interaction
- Referrals to services
- Coordinate care with providers including schools and Community Based services.
- Assist with consent / confidentiality issues.
- Assist with Fair Hearings / court ordered services.
- Schedule clinical appointments, make reminder calls, and track kept and not kept appointments.
- Create and maintain tickler system for child-specific mandated services in developmental and mental health treatment.
- Type clinical reports memos letters, and other reports for the department.
- Photocopy, distribute, and file reports and other written materials.
- Log and distribute requests for clinical services to appropriate staff.
- Distribute and track completed clinical reports.
- Track Continuing Education credits, licensure, and malpractice insurance of clinicians.
- Prepare and maintain records of department purchases.
- Handle incoming and outgoing mail for the department.
- Maintain up-to-date treatment case lists on each clinician.
- Interact with clinical and billing staff
- Oversees all business functions
- Perform other secretarial duties as requested by Medical Director.
- Any other related duties as required
PHYSICAL REQUIREMENTS
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. An employee in this position is regularly required to stand; walk, use hands and fingers, handle, or feel objects; reach with hands and arms; talk and listen, and taste or smell. The employee frequently is required to walk. The employee is occasionally required to keep balance and stoop, kneel, crouch, or crawl.
- Computer The Medicaid Managed Care Liaison must be able to use a computer and able to learn software programs
- Office Equipment- The Medicaid Managed Care Liaison is required to operate a fax, copier, scan, and other office equipment.
- Communication - The Medicaid Managed Care Liaison needs to be able to speak, read and write fluently in the English language
- Writing - The Medicaid Managed Care Liaison must be able to write in the English language using correct spelling, grammar, punctuation, etc.
- Lifting - The Medicaid Managed Care Liaison may frequently lift 0-25 lbs., occasionally lift 25-50 lbs., and rarely lift over 50 lbs.
- Push/Pull - The Medicaid Managed Care Liaison may frequently push/pull 0-25 lbs. of force, occasionally push/pull 26-45 lbs. force, and rarely push/pull over 45 lbs.
- Sitting, Standing and Walking The Medicaid Managed Care Liaison will be required to sit, stand and walk throughout the work day.
- Stooping -The Medicaid Managed Care Liaison may occasionally stoop. This is defined as bending body downward by bending spine at the waist.
- Kneeling -The Medicaid Managed Care Liaison may occasionally kneel. This is defined as bending legs at knees to come to rest on knee(s).
- Crouching - The Medicaid Managed Care Liaison may occasionally crouch. This is defined as bending body downward and forward by bending spine and legs.
- Work environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. While performing the duties of this job, the employee frequently works in an office environment. The noise level in the work environment is usually moderate due to talk and movement of the program participants and other co- workers. The noise level can increase on occasion due to yelling or screaming by the participants of the programs.
QUALIFICATIONS
Experience:
- Minimum 3 years experience in a medical or social services office environment.
- Knowledge and use of computers.
- Experience with Electronic Health Records a plus.
- Excellent Typing skills.
- Excellent Data entry skills.
- Familiar with NYS Child Welfare protocols.
- Organizational skills.
- Good Communication and collaboration skills.
Required background checks:
- NYS Statewide Central Register of Child Abuse and Maltreatment (SCR)
- NYS Sex Offender Registry (SOR)
- NYS Division of Criminal Justice Services (DCJS) fingerprinting
- NYS Justice Center Staff Exclusion List (SEL)
- NYS OMIG Medicaid Exclusion List
- Complete mandated reporter training
Education:
- High school diploma minimum; BA/ BS/ MPA preferred
HOURS AND TIME OF WORK
Full-time: 35 Hours per Week
