General
Purpose:
The Medicaid
Specialist acts as a liaison between patients, skilled nursing facility, and
government agencies, ensuring
that residents receive the benefits they are entitled to and that applications are processed efficiently and accurately.
Essential
Job Functions:
This facility expects their employees to promote an atmosphere of teamwork with other employees,
hospitality, and comfort for its residents. Therefore, the following list of duties is not all-inclusive:
- Prepare and submit reports on a timely basis as required and directed by Business Office manager,
Administrator, this company and governmental agencies.
- Secures documentation for Medicaid/MSP new applications and renewal applications if needed for members’
attention to detail by adhering to state requirements and securing
supporting documentation.
- Collaborates with government offices to accurately complete the application and recertifi-
cation process.
- Meets daily, weekly, and monthly production goals. Must also meet quality standards by en- suring proper phone etiquette
and adherence to scripts, state regulations, HIPAA compli-
ance, meet ongoing
corporate compliance standards, and make accurate and descriptive
documentation.
- Review financial
statements, check personal
information, and analyze
eligibility requirements.
- Contact Medicaid
with problems of recertification and budget determinations.
- Accumulate and maintain, in an organized manner, vital statistics relating to admissions,
discharges, deaths, transfers and daily census
of facility residents.
- Bill Medicaid
claims weekly.
- Responsible for weekly Medicaid billings along with timely follow-up with intermediaries on delinquent payments.
- Monitor
and manage the accounts receivable collection process.
- Pursue past due accounts persistently and maintain proper back-up documentation
- Obtain and submit all required documentation to bill third party payers as per program/company guidelines.
- Verify
that resident trust is accurately recorded.
- Provide statistics to audit and reimbursement for year-end • processing.
- Maintain an accurate accounting of patient trust funds including monthly reconciliation and quarterly
statements to responsible parties. Reconcile petty cash for Patient Trust Fund
daily.
- Participate in the resident admission process by providing explanations of the facility’s
rates, billing cycle and payment terms, including collecting the first month’s advance
payment upon admission.
Other Duties:
- Attend in-service education programs in order to meet facility educational requirements.
- Be familiar with Standard Precautions, Exposure Control Plan, Fire Drill and Evacuation
Procedures and know how to use the information.
- Maintain
confidentiality of resident and facility records/information.
- Protect residents from neglect, mistreatment, and abuse.
- Others as directed by the supervisor or administrator.
Minimum Qualifications:
- Business Degree or experience in health care facility; office management preferred.
- Organized
and detailed in work performance.
- Good communication skills with excellent self-discipline and patience.
- Genuine caring for and interest in elderly and disabled people in a nursing facility.
- Comply with the Residents’
Rights and Facility Policies and Procedures.
- Perform work tasks within the physical demand requirements as outlined below.
- Perform Essential
Duties as outlined above.
