Medicaid Specialist

St Camillus Residential Health; New York (NY); On-site; USD 42,000 - 68,000; Full time

Benefits offered by this job

Generous Paid Time Off

Health/Dental/Vision Plans

Company Funded Life Insurance and HRA

Retirement Plan

On-site parking

On-site cafeteria

Job summary

St. Camillus Residential Health is seeking a Full Time Medicaid Specialist to join the Patient Financial Services team. The role focuses on Medicaid eligibility, NAMI estimation, and timely Medicaid application submissions within a skilled nursing facility setting.

You will coordinate with PFS and Finance, residents, and families, ensuring regulatory compliance and accurate billing. This position emphasizes teamwork and independent project management in a healthcare environment.

Qualifications

• Associate’s Degree is required.
• Experience in Medicaid Eligibility and/or Skilled Nursing Facility Medicaid billing.
• Strong Microsoft Office experience (Word and Excel).
• Strong verbal, written, computer and leadership skills.
• Ability to work independently while managing multiple projects.
• Must be a team player and build strong relationships with residents and families.

Responsibilities

• Review insurance coverage with families to determine Medicaid eligibility and financial liability.
• Determine estimated Net Available Monthly Income (NAMI).
• Complete, monitor and submit Medicaid applications and recertifications on time.
• Maintain knowledge of third party billing regulations.
• Assist with day-to-day billing tasks as needed.
• Support audits initiated by external agencies (OMIG, SSA).

Skills

Medicaid eligibility

Microsoft Office

Communication skills

Team collaboration

Education

Associate’s Degree

Job description

Job Description

Become Rooted in Caring for Life with St. Camillus!

At St. Camillus, we're centered on celebrating our Employees! Our team is what makes St. Camillus an amazing place to work.

We are currently a Full Time Medicaid Specialist to join our Patient Financial Services Team!

Responsibilities:

This position will work with the staff in the Patient Financial Services (PFS) and Finance departments, as well as with residents/family members, including, but not limited to, reviewing insurance coverage with families to determine financial liability and/or need for Medicaid; determining estimated Net Available Monthly Income (NAMI); completing, monitoring and ensuring timely submission of Medicaid applications and recertification’s; maintaining knowledge of third party billing regulations; and assisting with the day-to-day billing functions as needed.

• Must be knowledgeable of the most current Medicaid regulations and the Medicaid application process.
• Responsible for reviewing insurance coverage with families as needed throughout their stay, detailing any potential financial liability and determining whether/when Medicaid will be needed.
• Responsible for estimating residents’ NAMI and ensuring NAMI income comes to the facility.
• Responsible for the completion of residents’ Medicaid applications and annual recertification’s within specific timeframes.
• Must track the Medicaid application submission deadlines and status and have continual communication with the local DSS office, St. Camillus staff, and our residents/their family members to ensure timely approval and increased cash flow.
• Must ensure all required documentation is obtained from the family or work with their financial institution, etc. to obtain the information on their behalf.
• Responsible for completing and submitting all requested Medicaid forms and documents such as LDSS 3559s, Nursing Home Account Sheets, PRIs, etc.
• Maintain accurate records of member’s eligibility status, recertification dates and MLTC provider.
• Must be knowledgeable on general skilled nursing facility payers and billing procedures.
• Utilizes various financial reports to follow Private accounts that may need Medicaid.
• Once Medicaid applications are approved, enter the information into the billing system for processing.
• Reports all Medicaid application issues to the PFS Manager, Director of Finance and VP of Finance on a routine basis.
• Provide written referral and backup documentation on Medicaid cases requiring attorney involvement.
• Responsible for assisting with billing tasks as needed.
• Responsible for assisting with any financial audits initiated by outside agencies, including but not limited to the Office of the Medicaid Inspector General (OMIG) and Social Security.
• Support department Manager, Director of Finance, and VP of Finance with all required tasks.
• Responsible for employee injury prevention, follows safety rules and addresses safety issues with supervisor.
• All other duties as assigned by supervisor.

Qualifications:

• Associate’s Degree
• Experience in Medicaid Eligibility and/or Skilled Nursing Facility Medicaid billing.
• Strong Microsoft office experience (Word and Excel)
• Strong verbal, written, computer and leadership skills are required.
• Must be a team player and be able to build strong relationships with our residents and their families.
• Must be able to work independently managing multiple projects at once.

Employee Benefits:

• Generous Paid Time Off!
• Affordable Health/Dental/Vision Plans
• Company Funded Life Insurance and Health Reimbursement Account
• Retirement Plan
• On the Centro Bus Line
• Free parking
• On-site cafeteria

Why Work At St. Camillus?

Our Mission: St. Camillus is a non-denominational, not-for-profit organization dedicated to caring for life through a broad range of health care services.

Our Vision: To be the provider of choice for compassionate and innovative care.

For more information about St. Camillus and Integrity Home Care Services visit our website at http://www.st-camillus.org

EOE/Affirmative Action Employer