Medicaid 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

The Medicaid Specialist is responsible for the timely and accurate completion and review of Medicaid Pending applications to ensure all required documentation is made available and gathered for timely processing to the County. Further is responsible to ensure that policy and procedures in the business office are followed in accordance with current applicable Federal, State and local standards, guidelines and regulations. Ensures that all information uploaded into the billing software is accurate and completed promptly.

• Works one on one with residents, responsible parties, and families to ensure the Medicaid Application process starts within 24-48 hours of admission for any admission that will become Medicaid Pending. Secures authorizations to represent as applicable.
• Educates residents, responsible parties, families in the Medicaid Process and communicates documents required to complete the Medicaid Application.
• Informs Business Office Manager promptly if there is no cooperation or a delay in cooperation from a resident, responsible party, family in the Medicaid Application Process
• Ensures complete confidentiality of financial, HIPAA protected information of residents
• Responsible for the completion of the Options package for Aging and Adult Services for the clinical approval of Medicaid.
• Responsible for the tracking and ensuring the MA51 is returned from the physician timely. Further is responsible for ensuring the MA51 and the PASSAR match as it may result in a clinical denial.
• Responsible to forward the OBRA letter with the Medicaid application if the resident tis deemed a Target admission by the Commonwealth of Pennsylvania and an Options request is not needed. Responsible for obtaining such documentation from the Social Services or Admissions Department.
• On a daily basis will call residents, responsible parties, families and financial institutions and other affected agencies and financial institutions to assist in attempting to obtain a large number verification that is needed by the Commonwealth of Pennsylvania to secure a Medicaid Grant
• Responsible for ensuring Spousal cases include the additional information required by the County to ensure a timely processes and approval of a Medicaid Application.
• Responsible to ensure the resident and or responsible party or family member understands and signs the Patient Liability which is due on a monthly basis
• Responsible to ensure that Direct Deposit if secured. Reports to the Business Office Manager if there is no compliance and a Rep Payee is secured for Social Security
• Responsible to complete the Rep Payee Application and ensuring the Rep Payee Application is completed promptly and accurately
• Responsible to keep and update the Medicaid Pending log on a daily basis
• Works collaboratively with the applicable County office to ensure they have all required documentation
• Responsible to attend face to face interviews at the County Assistance Office in order to secure a grant if families are uncooperative or unable to attend
• Responsible for ensuring the County Assistance Office is in receipt of all verifications.
• Responsible for ensuring that when the Medicaid Grant is obtained the appropriate persons (third party biller, BOM and RNAC) are notified.
• Responsible for ALL active in-house Medicaid resident’s yearly recertifications.
• Comply with Health Insurance Portability and Accountability Act (HIPAA) regulations
• Must be an active participant in the facility’s Quality Assurance/Performance Improvement (QAPI) program and Performance Improvement Project (PIP) and carry out roles and responsibilities as assigned. Must attend trainings for QAPI, follow policies and procedures in support of QAPI efforts, and support QAPI initiatives and findings. Must also report potential or actual non-compliance issues to the facility’s QAPI committee.
• Perform other reasonable duties as assigned by supervisor.

Required 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.