Medicaid Specialist

Topaz Fiscal Services; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Topaz Fiscal Services seeks a Medicaid Specialist to manage Medicaid Pending Applications and Renewals to ensure financial eligibility for required dates of service.

The role involves processing forms per GA policy, meeting families, tracking case progress in the EMR AR module, and coordinating with Medicaid offices to ensure timely status updates.

Qualifications

• Strong organizational skills with attention to detail.
• Good verbal and written communication skills.
• Medicaid and skilled nursing facility background preferred.

Responsibilities

• Medicaid Pending Applications & Renewals processing to determine financial eligibility.
• Meet families/responsible parties and obtain paperwork for Medicaid applications.
• Monitor progress of pending Medicaid cases and renewals in the EMR AR module.
• Follow up with county Medicaid office on case status per policy.
• Notify BOM/Administrator/RFA of potential problems or noncompliance promptly.
• Participate in Medicaid Pending AR meetings as scheduled.
• Upload documentation to EMR Miscellaneous Tab and GA Medicaid portal.
• Respond to discontinuation/denials by determining actions (appeal, reapplication, acceptance).
• Performs other duties or projects as assigned by Business Office Manager.

Skills

Organizational skills

Verbal and written communication

Education

High School Diploma or GED

Job description

PositionSummary:

Medicaid Specialist wi ll be responsible for working on Medicaid Pending Applications and Renewals to ensure financial eligibility for the dates of service neededto secure valid Medicaidpayer status for the facility.

Responsibilities:

• Medical Assistance Applications & Renewals includingprocessi ng of a ll appropriate forms applicabl e to theState per GA Medicaid (GA Department of Family and Children Services) Policy and Procedures.


• Meet with the families/responsible party,by GA Medicaid Policy and Procedures guidelines, and determine and obtain paperwork needed tocomplete the Medicaid application.


• Monitor and document the progress of the pending Medicaid cases and Re newals in the EMR A/R Collection Module per the facility’s policy and procedures.


• Follow up with the county Medicaid office on status of cases per GA Medicaid Policy & Procedures.


• Communicatetimelyto BOM, Administrator, and RFA of any potential problem cases or noncompliance by family/responsible parties per GA Medicaid Policy & Procedures.


• Part i cipate in Medicaid Pending AR Meetings to review all Medicaid Pending cases (as scheduled).


• Up lo ad appropriate documentation to the facility’s EMR Miscellaneous Tab and to the GA Medicaid portal.


• Responds to case discontinuation and / or denials by determining the action required which may include Appeal, Reapplication or Acceptance.


• Performs other duties or projects as assigned by Business Office Manager.

Skills:

Must havestrongorganizationalskills with a good sense of detail.Good verbal and written communication skills.

Experience:

Medicaid and skilled nursing facility background preferred.

Education:

High School Diploma or GED required.

For more Information regarding the HB531 Florida Agency for Health Care Administration, please visit: https://info.flclearinghouse.com