Consulate Health Care Medicaid Specialist (Remote) in Florida
Job ID 85490
Position Location US-FL-
Alternate Position Location St Augustine/FL; Titusville/FL
Facility Name Florida Region - North, Daytona Beach Area, Florida
Job Category Finance - Billing
Position Status FT is 35+ HOURS WK
Purpose of Your Job Position
As a Consulate Health Care employee, you are entrusted with the responsibility of carrying out your daily tasks and assigned duties while demonstrating Consulate’s Core Values of Compassion, Honesty, Integrity, Respect and Passion. You are expected to provide innovative, responsible results with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results. The primary purpose of your job position is to assist facility staff with the Medicaid Application process
As a Medicaid Specialist, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Responsible for educating in regard to the process, validating the process is efficient once implemented and developing plans for reducing days in AR related to Pending Medicaid balances. This position is a non-supervisory function. This job description does not list all the duties of the job. You may be asked by supervisors or managers to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description. The employer has the right to revise this job description at any time, for any reason.
Duties and Responsibilities
Responsible for the oversight and success of the pending Medicaid application process for a group of assigned skilled nursing facilities.
Educate Care Center staff regarding the pending Medicaid application process, including identification of all pending/recertification files, incomplete 3008 forms, timely completion of PASRR II assessments, citizenship issues, unsigned documents, missing financial information, evaluation of income & asset levels for potential admissions and residents already admitted.
Provide guidance to Care Center staff in determining appropriate actions needed to resolve applicant status if ineligible.
Assess high risk direct admit No Payer - Medicaid Pending with Executive Directors and Admission Directors through the pre-admission screening process.
Assist with all levels of Disability application processes including assistance w/web based application and phone interviews.
Ensure effective processes are in place at the Care Centers for processing Pending Medicaid application, recertification documentation and tracking the status of open pending Medicaid applications
Troubleshoot previously denied files including obtaining previously unattained documentation, including advising on appeal processes and time restraints attached to appeal limits per state protocol
Communicate with government agencies when needed
Attend State sponsored seminars/trainings associated with the Skilled Nursing Facility Pending Medicaid processes; communicate and educate at the Care Center level
Stay abreast of State updates to Skilled Nursing Pending Medicaid updates-communicate and educate to the Care Center level
Determine and discuss the need for Medicaid service companies/attorney offices to address income levels, asset levels, Qualified Income Trust needs and Guardianship needs.
Recommend to Care Centers when a 30 day notice should be considered to any resident or designated representative that non compliance with submission of documentation needed to complete the Medicaid application process as required by Department of Children and Families, Social Security Administration and other regulatory agencies.
Identify underlying issues with Medicaid Pending policies and procedures on a Care Center level. Develop and implement training on procedures and provide support to Medicaid designated staff to streamline the application to eligibility process.
Determining the best course of action to resolve issues in both the pending Medicaid files as well as recertification issues.
Analyze the status of all Medicaid pending account balances and develop strategies for resolution of outstanding balances
Provide status reports and develop action plans to resolve outstanding Medicaid pending balances.
Perform all other duties, as assigned.
Works in office areas.
Moves intermittently during working hours.
Is subject to frequent interruptions.
Works beyond normal working hours, weekends and holidays and on other shifts/positions as necessary.
Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.).
Attends and participates in continuing educational programs.
Is involved with government agencies and personnel, etc., under all conditions and circumstances.
May be subject to the handling of and exposure to hazardous chemicals.
Must possess, as a minimum, a high diploma or its equivalent, two-year degree preferred.
Computer literacy skills (Microsoft Outlook, Microsoft Office, Internet).
Three to Five years of professional experience and/or training; or equivalent combination of education and experience.
Must have 3 years experience as one of the following: 1) Skilled Nursing Medicaid billing & eligibility screening or 2) Social Worker with Medicaid eligibility processing experience or 3) Other role serving as a Medicaid eligibility liaison with Medicaid eligibility processing experience.
Must have experience with Excel and Microsoft Office programs.
Must possess knowledge of and demonstrated skill with the pertinent billing software.
Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition and grammar.
Knowledge of principles and processes for providing customer services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
Must possess the ability to prioritize duties and responsibilities.
Must be knowledgeable of computer systems, system applications, and other office equipment.
Effective verbal and communication skills
Understanding written sentences and paragraphs in work related documents.
Actively looking for ways to help people.
Communicating effectively in writing as appropriate for the needs of the audience.
The ability to read and understand information and ideas presented in writing.
Ability to prioritize multiple tasks, work effectively under stress, meet short deadlines, take direction and perform assigned duties with minimum supervision.