Medicaid Specialist Field Staff

The Alden Network; Chicago (IL); On-site; USD 55,000 - 70,000; Full time

Job summary

The Alden Network is seeking a Medicaid Specialist Field Staff responsible for overseeing the Medicaid application process for residents in Chicago, Illinois. This role involves meeting residents and their families in person to ensure compliance with eligibility criteria.

The ideal candidate will have a Bachelor's degree and advanced knowledge of the Illinois Public Aid system. This is an on-site position, requiring travel to facilities Monday through Friday. Strong communication skills and proficiency in office software are essential.

Qualifications

• Bachelor's degree or equivalent experience in Medicaid applications.
• Experience in long-term care and knowledge of benefit portals is preferred.
• Ability to travel to facilities Monday through Friday.

Responsibilities

• Initiate the Public Aid process for new residents.
• Monitor payer changes daily for facility residents.
• Gather necessary documentation and assist residents weekly until application is complete.

Skills

Advanced working knowledge of the Illinois Public Aid system

Effective communication skills

Proficiency using computers and standard office software

Education

Bachelor's degree in a related field

Tools

Microsoft Excel

EMR systems

Job description

Job Summary

The Medicaid Specialist Field Staff is responsible for overseeing and executing the Medicaid application process for residents, ensuring compliance with eligibility criteria and documentation standards. This role meets with residents and their families in person or virtually to obtain, verify, and submit complete and accurate Medicaid applications within required timeframes. The specialist serves as the main point of contact throughout the public aid application process and maintains ownership of the application from initiation through submission, mitigating risk of delays, denials, or non‑payment by ensuring adherence to existing guidelines and facility protocols.

Qualifications

• Bachelor’s degree in a related field or demonstrated experience with the Medicaid application process or related work.
• Advanced working knowledge of the Illinois Public Aid system; working knowledge of the Wisconsin Public Aid system is preferred.
• Experience working in long‑term care and a working knowledge of related benefit/eligibility portals is preferred.
• Effective communication skills, adaptable to changes in assignments and priorities.
• Must be able to travel to Alden facilities and work on‑site Monday through Friday; remote work is not available for this role.
• Must be able to read, write, and speak English in an understandable manner.
• Ability to make independent decisions when circumstances warrant such actions.
• Capability to deal tactfully with families, residents, visitors, personnel, regulatory agencies, and the general public.
• Patience, tact, a cheerful disposition, and enthusiasm.
• Proficiency using computers and standard office software such as Microsoft Excel, Microsoft Outlook, and EMR systems; ability to learn new software systems as needed.

Physical Requirements

• Must be able to move intermittently throughout the workday.
• Must be able to cope with the mental and emotional stress of the position.
• Must possess sight/ hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
• Must be in good general health and demonstrate emotional stability.
• Must be able to relate well and work with the ill, disabled, elderly, emotionally upset and at times hostile people within the facility.
• Prolonged standing/walking is required.
• May be required to lift, push, pull, and move equipment, supplies, etc., throughout the day.
• Is subject to exposure to infectious waste, diseases, conditions, etc., including exposure to the (HIV) AIDS and Hepatitis B viruses.

Essential Functions

• Prior to admission, contact public aid pending residents and/or their responsible party to obtain necessary information, documents, forms, and financial information needed to initiate the Public Aid process.
• Monitor PCC daily for respective facilities to identify payer changes and to identify residents who need to apply for Medicaid.
• Contact the resident and/or responsible party within 48 hours of admission, or within 48 hours of being notified of a payer status change to inform them of their financial responsibilities and complete the Income Due Alden Form (if necessary), 2998 and 3654, and to discuss the Medicaid qualifications and document requirements. Provide a copy of the public aid checklist and explain the checklist in detail to ensure understanding of their financial responsibilities.
• Contact the resident and/or responsible party weekly (every 5 days) to assist in gathering necessary documentation and review provided documentation for accuracy upon receipt. Continue to follow up weekly until the public aid application is completed, submitted, and accepted.
• If unable to contact a resident or their responsible party after consistent attempts for a period of two weeks, escalate the situation by scheduling a meeting with the facility Administrator, Admission Director and Social Service Director to review the case and discuss potential guardianship needs.
• Maintain accurate documentation in EMR or related system regarding the progress and status of the application process and detailed documentation of all follow‑up communication with the resident and/or their responsible party.
• Once all documentation is obtained, complete and submit the Application for Benefit Eligibility (ABE) using information provided by the resident and/or their responsible party; ensure a copy of submitted application is uploaded to the EMR, and monitor the application status by checking the eligibility portal (One Source or Medi) on a weekly basis. Once submitted, notify the PA Coordinator via email.

Job Duties

• If an asset spenddown is necessary, guide the resident and/or their responsible party in spending money appropriately.
• Respond to all DHS requests and gather additional information as necessary.
• Communicate regularly with the facility for updates on Notices of Decision.
• Review approval letters for accuracy and upload to EMR.
• Review denials and file an appeal within 60 days from the date of the denial notice.
• Attend telephonic appeal meetings and present the case to the Bureau of Hearings.
• Assist with the Medicaid Redetermination process by communicating with residents and/or their responsible parties to obtain documents needed to successfully complete the REDE for active residents.
• Work with resident and/or their responsible party to collect and review all documents requested by OIG for pending cases and submit requested documentation in a timely manner.
• Perform other duties as assigned.