Medicaid Eligibility & Applications Specialist

Premier Healthcare, LLC; Washington (Washington County); On-site; USD 42,000 - 66,000; Full time

Job summary

Premier Healthcare, LLC is seeking a Medicaid Specialist to oversee the Medicaid Pending applications, ensuring all required documentation is gathered for timely processing. You will work with residents, families, and the Business Office to comply with Federal, State, and local standards while safeguarding HIPAA information.

You will educate parties on the Medicaid process, manage MA51/PASSAR verifications, and coordinate with county agencies to secure grants and approvals.

Qualifications

• Must have two years of work experience in Long Term Care.
• Must be efficient, maintain confidentiality, exhibit good judgment, and have the ability to speak and write effectively.
• Must possess good communication and people skills.
• Must be knowledgeable of all Medicaid legal regulations, guidelines and best practices.
• Must understand the basics of working in the business office and importance of following established processes.
• Must possess an aptitude for problem solving.
• Employment is contingent on completion of all pre-employment screenings inclusive of criminal background check and Medicaid Exclusion Screening, both indicating negative results.

Responsibilities

• Works one on one with residents, responsible parties, and families to start Medicaid Pending within 24–48 hours of admission.
• Educates residents and families in the Medicaid process and documents required to complete the application.
• Secures authorizations to represent as applicable.
• Informs Business Office Manager promptly if cooperation delays occur.
• Ensures confidentiality of financial and HIPAA information.
• Tracks MA51 forms and ensures match with PASSAR to avoid clinical denial.
• For residents deemed Target admissions, forwards OBRA letters and obtains documentation.
• Daily outreach to residents, families, financial institutions to obtain verifications for the Commonwealth.
• Ensures spousal cases include required information for timely processing.
• Ensures patient liability payments are understood and signed monthly.
• Works with third party biller and Rep Payee processes to secure Direct Deposit.
• Completes Rep Payee applications promptly and accurately.
• Keeps Medicaid Pending log updated daily.
• Collaborates with County offices to gather required documentation.
• Attends face-to-face interviews at the County Assistance Office to obtain grants when families are uncooperative.
• Ensures County Assistance Office receives all verifications.
• Notifies third parties when Medicaid Grant is obtained.
• Responsible for all active in-house Medicaid resident yearly recertifications.
• Complies with HIPAA regulations.
• Active participant in QAPI/PIP; attends trainings and reports non-compliance.
• Perform other reasonable duties as assigned.

Skills

Long Term Care Experience

Job description

Premier Healthcare, LLC is seeking a Medicaid Specialist to oversee the Medicaid Pending applications, ensuring all required documentation is gathered for timely processing. You will work with residents, families, and the Business Office to comply with Federal, State, and local standards while safeguarding HIPAA information.

You will educate parties on the Medicaid process, manage MA51/PASSAR verifications, and coordinate with county agencies to secure grants and approvals.