Medical specialist

Benefits :

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Responsibilities :

• Initiate assist, and manage Medicaid applications for prospective participants, ensuring timely and accurate completion of the process, completing all necessary paperwork for Medicaid re-determination or new applications, offering guidance through complex processes.
• Conduct home visits to assist participants with completing the Medi-Cal application process, providing a supportive and hands-on approach.
• Conduct visits to the county offices, as needed.
• Maintain accurate documentation and record all participant enrollment information in CRM software, ensuring data integrity and compliance with internal procedures.
• Collaborate with the Finance Director / Analyst to prepare various reports for data analysis, supporting financial transparency and decision-making.

Validate Medicaid payment, ensuring accurate and timely payment processing

• Check Medicaid eligibility using DHCS online portal for all participants per month and as needed
• Processing Share of Cost transactions via DHCS online portal
• Monitor and maintain participants' Medicaid eligibility, including managing the recertification process for Medi-Cal, ensuring no lapses in coverage.
• Assist the Business Development team as needed, offering additional support during high-volume periods or special initiatives.
• Collaborate with or contact county / state government specialist to ensure the submission of required documentation or to obtain additional information when needed.
• Other duties as assigned.

Education & Training :

• Associate degree or higher preferred
• Minimum two years’ experience working in case management, Medicaid eligibility, and clinical documentation required
• One year experience working with elderly, PACE, or the Medi-Cal process preferred

Skills & Abilities :

• Work independently and as an effective member of a team.
• Establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, members, providers and the public.
• Communicate effectively, both verbally and in writing, with individuals from varying cultural backgrounds.
• Prepare concise and clear reports.
• Effectively utilize computer and appropriate software and interact as needed with High Desert PACE Information Systems.
• Foster and model an effective team environment, where each team member is held accountable for their independent work.
• Approach leadership with an openness to new ideas, cultural humility and acknowledgment of the dynamics of privilege.

Knowledge of

• Principles and practices of health care, health care systems, and managed care
• Medi-Cal benefits and regulations
• Community-based organizations, agencies, and community services
• Team and value-based care
• Regulatory policies, rules, and regulations

Working Conditions :

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Primarily work indoors.
• Hybrid, flexible schedule.
• Ability to travel to enrollees / participants home and county office.
• Are exposed daily to participants who have diseases or infections.
• Wear protective clothing such as a gown, masks, and gloves, as needed.
• While performing the duties of this job, the employee is frequently required to walk, sit, and / or stand.
• The employee must occasionally lift and / or move up to 25 pounds.

The Job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.

The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Last updated : 2024-11-23

Salary : $22 - $28