Medicaid specialist job description

Job Functions, Duties, Responsibilities and Position Qualifications:

Overview
Responsible for the management of Medicaid accounts through patient written and verbal directions, aged trial balance reports, and Medicaid rejection reports for the accurate and timely filing of claims for maximum reimbursement. Ability to provide support to other Accounts Receivable departments, as needed. Adhere to all departmental policies and procedures.
ResponsibilitiesCustomer service duties include answering telephones for patients and others regarding billing inquiries and resolving billing issues in a professional manner.Act as resource to CPL personnel and clients regarding Medicaid compliance guidelines.Accurately enter information provided by various sources to correct claims in regards to CPT and ICD-10 codes and send out in a timely manner to Medicaid.Audit accounts showing Medicaid denials to resolve balances.Ability to interpret Explanation of Medicaid benefits.Resolve invoices from outside laboratories for Medicaid patients.Submitting and retrieving eligibility requests through TDH Connect.Communicating with the Team-leader or Supervisor on areas that may be improved and appeals minimized.Ability to stay work focused and perform job duties efficiently and accurately as well as meet the production standards as set by the Accounts Receivable Director. Must have strong organizational skills.Employee must comply with CPL's compliance policies and procedures.Duties include but are not limited to the above mentioned responsibilities.
Scope: Respects and maintains the confidentiality of information relative to the laboratory. Adheres to all accounts receivable policies, procedures and compliance guidelines. Works with minimal direction, consults with Team-leader or Supervisor as needed.

QualificationsEducation: High School Diploma or GED.

Experience: Preferred at least two years in a standard Medicaid or related Star plans in a multitask environment, including customer service. Strong background in coding procedures preferred. Bilingual skills, private insurance experience and/or lab billing a plus.

Skills: Ability to communicate effectively at all levels within the company and with patients and physician office staff. Knowledge of microcomputer technology and terminology. Ability to type and demonstrate 10 key proficiency and current departmental standards is required. Develop effective and harmonious work habits and relationships. Ability to read and comprehend English.

Additional InformationMust be able to successfully complete pre-employment background check and drug screen, EOE.

Scheduled Weekly Hours:
40

Work Shift:
1st Shift (United States of America)

Company:
Sonic Healthcare USA, Inc

Sonic Healthcare USA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Communicare Health Services is currently recruiting a dynamic individual with prior Business Office or Admissions experience in Long Term Care for the position of Regional Medicaid Specialist for our facilities located in the Southern Indiana region. Some travel between our facilities in the area is required. This position also requires travel as necessary including but not limited to a resident and/or responsible party home to collect documentation to support applications submitted, financial institutions, Local Department of Job and Family Services.

The position of Medicaid Specialist provides assistance with the coordination of financial benefits available to the residents in our Caring Communities. The position must function as both a team member and leader to ensure that work is accomplished and quality service is delivered, supporting team members and leading the way in celebrating team successes. While focusing on delivering quality service, the position must also manage the resources within their control and assist others in managing resources.
Responsibilities of the Medicaid Specialist position include:

+ Assist the facility with gathering financial data from the resident, family and responsible party.

+ Review verifications and determine if qualifications for benefits have been met.

+ Complete and submit applications to state Medicaid programs

+ When appropriate become the authorized representative when applying for benefits

+ Maintain proper documentation to support efforts with all applications submitted.

+ Escalate difficult cases to management timely

+ File appeals with the appropriate agency when necessary

+ Build working relationships with local agency which produces the Level of Care/Pasarr Screen and local agency which determines Medicaid Eligibility

+ Attend all Medicaid Pending Meetings for assigned facilities.

As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer you a menu of benefit options from life and disability plans to medical, dental and vision coverage, from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.

Job Requirements:

+ Must be knowledgeable with laws, regulations, and guidelines that pertain to long-term care reimbursement.

+ 3-5 years of Long Term Care Business Office or Social Service experience in healthcare, preferably in a long term care setting

+ Must possess a thorough understanding of Medicare. Medicaid, Private Insurance, managed care programs

+ Must have the ability to make independent decisions when circumstances warrant such action.

+ Must be able to deal tactfully with team members, other staff, residents, family members, visitors, government agencies, and the general public.

+ Must be willing to seek out new methods and principles and be willing to incorporate them into existing practices.

+ Prior management training.

+ Basic computer literacy and skills.

+ Prior experience preferably with related software applications.

About Us

A family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients and family members care for and about one another.

We are looking for a talented Medicaid Specialist to join our Team at Victory Centre of Riverwoods!

• Achieve community occupancy and sales objectives.
• Back new inquiries immediately (phone-ins and walk-ins) or within 24 hours (all others). Return all phone calls within 24 hours.
• Greet visitors pleasantly and professionally and present an unambiguously positive image of the community and company as a whole.
• Skillfully guide prospects or their representatives to provide documentation needs.
• Effectively communicate and explain 1) VIVA! and the benefits of life in a Senior Living community; 2) the history of the development of the company; 3) the current residency monthly service fee structure, the application processing policy, and the current resident referral policy; 4) the types of floor plans, the basic features of each type and the availability of units within the community; and 5) the financial criteria required in order to move in, including conducting a pre-qualification on potential residents to ensure they are appropriate and meet the financial guidelines of the community.
• Provide tours and community information, including applications, to prospective residents, their families and other appropriate individuals. Provide prospective residents with a list of documents and all state-mandated information required.
• For pending move-ins, work with respective department resources necessary (if applicable) to complete residency agreements and financial disclosure forms, securing proper signatures, disclosures, and deposits if required. Coordinate move-in dates and apartment assignments for new residents in accordance with open apartments and vacant units. Communicate with and involve appropriate community staff in the decision making process required to determine residency.
• Maintain accurate records to document contact with prospective residents.
• Complete follow up calls to prospective residents and their family members regarding documentation needed for application.
• Attend community outreach events and develop relationships with social workers, discharge planners, physicians, religious institutions and other appropriate referral sources to build relationships with referral sources and generate referrals in accordance with the community's marketing plan.
• Submit accurate and timely reports to Executive Director and Regional Director of Sales and Marketing.
• Submit timely and accurate Bonus Requests to Executive Director in accordance with the commission policy in effect at the time.
• Coordinate planning, implementation and follow up of move ins to community with Community Team..
• Visit top four competitors annually and update competitive summary 2x/year.
• Develop and maintain resident referral program to generate referrals from residents and their families.

ADDITIONAL DUTIES:

• Ensure budgetary compliance through accurate and timely submission of invoices and check requests, adhering to company procedural standards for tracking expenses, and maintaining department within budget unless pre-approved by Executive Director.
• Develop general concepts and specific marketing themes with respect to the Marketing Program, implement the development of strategic networking and specialized events, direct mail and other advertising distribution programs, and select appropriate advertising media.
• Interact with others by developing and maintaining rapport, demonstrate interpersonal sensitivity toward others to establish a relationship and continue the sales process.
• Identify and anticipate customer thoughts and perceptions, seeking to identify the needs and goals of a potential resident and obtaining all financial and health information.
• Recommend solutions that match customer needs, overcoming objections by demonstrating benefits to customers and negotiating a mutually beneficial outcome.
• Maintain regular contact with prospective residents and their families to validate their interest and move them towards a decision, and record updates to customer information in YARDI.
• Work with the Executive Director to communicate to staff information on application issues impacting other departments.
• Responsible for being knowledgeable of any and all the Communities' policies, community service and procedures.
• Perform related duties as assigned or as the situation dictates.

SKILLS, KNOWLEDGE, ABILITIES REQUIRED:

• Must demonstrate empathy and compassion to connect with customers.
• Must be inspired to serve the needs of our customers.
• Must use imagination and creativity to motivate self and others.
• Must maintain confidentiality, especially with respect to resident health and financial information.
• Must be organized and able to multi-task prospective residents applications.
• Familiarity with computer-based software and applications for capturing sales data and word processing, in addition to knowledge of Microsoft Word, Excel, Publisher, email and Internet functions.
• Strong sales skills and ability to market the benefits of the company products and services.
• Understanding and effective implementation of all appropriate fair housing regulations.
• The ability to read, write and follow oral and written direction in the English language at a level adequate to perform the job duties.
• The Ability to effectively communicate, verbally and in writing, with potential customers, families and the general public.
• The Ability to overcome protests and concerns from potential residents and families considering choosing a Senior Living community.
• Proven ability to effectively process move-in and application.
• Ability to organize time and follow up to track leads for potential customers.
• Ability to work with the geriatric population.
• Must be available to work evenings, weekends and holidays when necessary.

At Pathway to Living, a Waterton company, we recognize that compensation and benefits are important to our associates. We offer a wide variety of benefits including:

• Full Medical, Dental, Vision insurance within 60 days following start date
• Vacation and Sick Time
• Daily Pay Available
• Paid Company Holidays
• 401(k) + matching
• Continuing Education
• Tuition Reimbursement
• HSA and FSA
• Life Insurance
• Disability Insurance
• Voluntary Benefits
• Backup Child and Elder Care
• Monthly cell phone stipend (where applicable)
• Employee Assistance Programs
• And so much more!

About Pathway to Living, a Waterton company


There's a lot to be said about having purpose in your work. At Pathway to Living, not only will you find meaningful work, but you'll enjoy a sense of community and joy. We are committed to leading a movement to change the way people think about aging and senior living. We help older adults fulfill dreams and accomplish goals - every day. We challenge the status quo, celebrate our communities, and embrace our Viva! Culture, which simply put, means long live! With over 40 communities across several states, we seek exceptional team members who believe that relationships matter and quality service and care are the ultimate priority.


Ready to join this movement? Please apply today for consideration!



Pathway to Living, a Waterton company, is an equal opportunity employer.Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.