Medicaid Specialist

Purpose/Belief Statement

The position of Medicaid Specialist provides assistance with the coordination of financial benefits available to the residents in our Caring Communities. The position must function as both a team member and leader to ensure that work

is accomplished and quality service is delivered, supporting team members and leading the way in celebrating team successes. While focusing on delivering quality service, the position must also manage the resources within their control

and assist others in managing resources.

Job Duties & Responsibilities

RESPONSIBLE FOR COORDINATING BENEFITS AVAILABLE TO OUR RESIDENTS.

REQUIRED MONITORS INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• ASSIST THE FACILITY WITH GATHERING FINANCIAL DATA FROM THE RESIDENT, FAMILY AND RESPONSIBLE PARTY.
• REVIEW VERIFICATIONS AND DETERMINE IF QUALIFICATIONS FOR BENEFITS HAVE BEEN MET.
• COMPLETE AND SUBMIT APPLICATIONS TO STATE MEDICAID PROGRAMS
• WHEN APPROPRIATE BECOME THE AUTHORIZED REPRESENTATIVE WHEN APPLYING FOR BENEFITS
• MAINTAIN PROPER DOCUMENTATION TO SUPPORT EFFORTS WITH ALL APPLICATIONS SUBMITTED.
• ESCALATE DIFFICULT CASES TO MANAGEMENT TIMELY
• FILE APPEALS WITH THE APPROPRIATE AGENCY WHEN NECESSARY
• BUILD WORKING RELATIONSHIPS WITH LOCAL AGENCY WHICH PRODUCES THE LEVEL OF CARE/PASARR SCREEN AND LOCAL AGENCY WHICH DETERMINES MEDICAID ELIGIBILITY
  
  

COMPLETE AND/OR ASSIST IN ALL DUTIES AND TASKS NECESSARY FOR TIMELY AND ACCURATE COMPLETION.

• MUST HAVE ABILITY TO EXECUTE INDEPENDENT ACTION AND TO LOGICALLY ORGANIZE OWN WORK.
• ATTEND ALL MEDICAID PENDING MEETINGS FOR ASSIGNED FACILITIES.
• DEVELOP AND MAINTAIN A GOOD WORKING RELATIONSHIP WITH THE FACILITY TEAMS, INCLUDING BUT NOT LIMITED TO: EXECUTIVE DIRECTOR, BUSINESS OFFICE MANAGER AND SOCIAL SERVICES.
• MAINTAINS CONFIDENTIALITY OF ALL RESIDENT/FAMILY INFORMATION AT ALL TIMES.
  
  

ATTEND AND PARTICIPATE IN SCHEDULED TRAINING, EDUCATION CLASSES, AND ORIENTATION PROGRAMS TO MAINTAIN AND ENHANCE QUALITY OF CARE.

• ATTEND COUNTY/STATE MEETINGS TO KEEP UP WITH REGULATORY CHANGES AND RESOLVE CONCERNS.
• ATTEND, PARTICIPATE, AND/OR LEAD FACILITY EDUCATIONAL IN-SERVICES WHEN APPROPRIATE.
• ATTEND ALL REQUIRED IN-SERVICE AND TRAINING PROGRAMS REQUIRED WITHIN YOUR DEPARTMENT.
  
  

Perform Other Related Activities As Assigned Or Requested.

• REQUIRES TRAVEL AS NECESSARY INCLUDING BUT NOT LIMITED TO A RESIDENT AND/OR RESPONSIBLE PARTY HOME TO COLLECT DOCUMENTATION TO SUPPORT APPLICATIONS SUBMITTED, FINANCIAL INSTITUTIONS, LOCAL DEPARTMENT OF JOB AND FAMILY SERVICES.
• MUST DEMONSTRATE SUPPORT WITH COMMUNICARE FAMILY OF COMPANIES CORE VALUES.
• PARTICIPATE IN FACILITY CARE TEAMS MEETINGS AND TEAM BUILDING ACTIVITIES.
• MAINTAIN CLEAN OFFICE AREA, ORGANIZED AND PRESENTABLE AT ALL TIMES IN ORDER FOR YOU TO BE ABLE TO MEET WITH RESIDENT AND/OR RESIDENT FAMILIES.
• ATTENDANCE MUST MEET FACILITY STANDARDS.
• PROMPTNESS IN REPORTING TO WORK.
• MUST DEMONSTRATE INTEREST AND ENTHUSIASM OF JOB.
  
  

MAINTAIN AND WORK WITHIN ESTABLISHED DEPARTMENTAL, CENTER, AND HOME OFFICE POLICIES AND PROCEDURES, OBJECTIVES, QUALITY IMPROVEMENT PROGRAM, AND SAFETY, ENVIRONMENTAL AND INFECTION CONTROL STANDARDS.

• PROMPTLY REPORTS ANY SUSPECTED RESIDENT ABUSE, NEGLECT OR MISAPPROPRIATION TO THE DON.
  
  

Qualifications & Experience Requirements

• 3-5 YEARS OF LONG TERM CARE BUSINESS OFFICE OR SOCIAL SERVICE EXPERIENCE
• PRIOR WORK/LIFE EXPERIENCES, PREFERABLY IN A LONG TERM CARE SETTING.
• PRIOR EXPERIENCE PREFERABLY WITH RELATED SOFTWARE APPLICATIONS.
  
  

Knowledge/Skills/Abilities

• Must be knowledgeable with laws, regulations, and guideline that pertain to long-term care reimbursement.
• Must possess a thorough understanding of Medicare. Medicaid, Private Insurance, managed care programs
• Must have the ability to make independent decisions when circumstances warrant such action.
• Must be able to deal tactfully with team members, other staff, residents, family members, visitors, government
• agencies, and the general public.
• Must be willing to seek out new methods and principles and be willing to incorporate them into existing practices.
• Basic computer literacy and skills.
  
  

Work environment

• May work beyond normal working hours, on weekends and holidays, when necessary.
• Is subject to frequent interruptions.
• Field based work required. Occasional overnight travel will be required as times with field based assignments.