ENROLLMENT SPECIALIST

Socket.dev; Ontario (OH); On-site; USD 38,000 - 60,000; Full time

Job summary

Socket.dev is seeking a Medicaid enrollment facilitator to assist individuals with applying for PASSPORT and Assisted Living Waivers. The role involves monitoring Medicaid status, coordinating with healthcare providers and agencies, and documenting progress in required systems.

The candidate will perform home visits as needed, maintain logs, and ensure timely communication with healthcare partners, while upholding confidentiality and agency standards.

Qualifications

• Knowledgeable in Microsoft Word and Excel.
• Ability to communicate professionally, respectfully and effectively.
• Ability to prioritize, organize and maintain accuracy in a flexible job environment.
• Ability to make sound decisions and demonstrate critical thinking skills.
• Ability to relate well with all individuals, community agencies, and Area Agency staff.

Responsibilities

• Facilitates enrollment of individuals onto PP or AL waiver by monitoring Medicaid application status and removing barriers.
• Maintains pending applicant tracking log.
• Utilizes Ohio Benefits, MITS, PNM applications to obtain and share eligibility status updates; networks with JFS caseworker and individual/caregiver to document update on application status.
• Coordinates with hospitals, nursing facilities, assisted Living facilities, managed care entities to facilitate transfer and/or enrollment.
• Completes Next Step phone call and template with the individual/representative within 5 business days of receiving assessment information.
• Keeps ODA required contact with pending Medicaid enrollment individual/representative every 30 days.

Skills

Microsoft Word

Excel

Education

High School diploma

Job description

Description

Summary

This position is established for the purpose of facilitating enrollment of individuals onto the PASSPORT and Assisted Living Waivers.

Essential Functions

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

1. Facilitates enrollment of individuals onto PP or AL waiver by monitoring Medicaid application status and working with individual/representative to remove barriers.
2. Maintains pending applicant tracking log.
3. Utilizes Ohio Benefits, MITS, PNM applications to obtain and share eligibility status updates. Also, networks with JFS caseworker and individual/caregiver to document update on application status and reason(s) for pending in PIMS every 15 days.
4. Networks with doctor offices and tracks obtaining PCP approval of waiver and LOC.
5. Completes Next Step phone call and template with the individual/representative within 5 business days of receiving assessment information.
6. Completes ODA required contact with pending Medicaid enrollment individual/representative every 30 days.
7. Coordinates with hospitals, nursing facilities, assisted Living facilities, managed care entities and other AAAs to facilitate transfer and/or enrollment.
8. Facilitates communication by providing release of information documents and/or assisting with phone calls to community entities to obtain information needed to assist with the enrollment process of individuals including, but not limited to: physician’s offices; banks; insurance companies; and funeral homes.
9. Makes home visits as needed to assist individuals with application process.
10. Notifies Compliance Coordinator when an individual is ready for CM assignment and amount of liability if one is assigned by JFS.
11. Assigns appropriate funding source to individual’s services.
12. Facilitates individual’s access to Medicaid State Plan or Medicare Skilled Home Care services.
13. Documents work activities in accordance with the Agency and ODA specifications and time frames in prescribed computer programs, including, but not limited to: PIMS, Access Logs, Ohio Benefits, PNM, Excel; and Word.
14. Updates, maintains and completes reports and lists as required and within required time frames.
15. Scans individual records as needed.
16. Completes special projects and activities as assigned.
17. Provides back-up support to other Units as needed.
18. Backs up and assists Medicaid Services Specialists as necessary.
19. Maintains and promotes positive working relationships among Agency staff and the Aging Network.
20. 20. Understands the Agency’s Conflict of Interest Policy and complies with the Ohio Aging Network’s requirements for disclosure.
21. 21. Assists with and completes special projects and activities as assigned.
22. 22. Participates in training to maintain and improve job skills.
23. 23. Performs duties with respectful communications & behaviors.

Requirements

1. Knowledgeable in Microsoft Word and Excel.
2. Ability to communicate professionally, respectfully and effectively.
3. Ability to prioritize, organize and maintain accuracy in a flexible job environment.
4. Ability to make sound decisions and demonstrate critical thinking skills.
5. Ability to relate well with all individuals, community agencies, and Area Agency staff.

Embraces and exemplifies the Agency’s 4 Keys of Excellence

• Safety
• Customer Service
• Courtesy
• Efficiency

Physical Demands

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.

While performing duties of this job, the employee is occasionally required to:

Carry job related items weighing up to 50lbs.

Stand; walk; sit, type, talk.

HIPAA/Confidentiality

Must maintain strict confidentiality and comply with all Agency HIPAA policies and procedures.

Travel

Ability to travel.

Education and Experience

High School diploma and 2 - 3 years related experience or education.

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.