What are the responsibilities and job description for the Medicaid Specialist position at Premier Healthcare, LLC?
- 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 and 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 or 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 to forward the OBRA letter with the Medicaid application if the resident is deemed a Target admission by the specific state where the facility operates. Will follow any guidelines state specific for completing the process
- 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 of verifications that are needed to secure Medicaid.
- Responsible for ensuring spousal cases include the additional information required by the county to ensure a timely process and approval of 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 is 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 that when Medicaid 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 initiatives and findings. Must also report potential or actual non-compliance issues to the facility’s QAPI committee.
- Assist BOM in collecting any outstanding Account Receivable.
- Perform other reasonable duties as assigned by supervisor.
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
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Camden County Board of Commissioners -
Woodbine, GA
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