Role: Medicaid Specialist

Organization: Edenbridge PACE West Baltimore

Location: West Baltimore
Start Date: July 2024

Status: Full-time

Mission: To allow frail elderly people to age in the location of their choosing and continue to lead
connected, meaningful lives
JOB SUMMARY
Under the direction of the Program Director, this position is responsible for establishing and maintaining Medicaid eligibility for PACE participants. This includes: preparation and submission of potential participants Medicaid applications, tracking and processing redeterminations (RRR) for participants, and serving as the organizations liaison to the Maryland Department of Health and case managers to expedite the application and enrollment process.
ESSENTIAL DUTIES AND RESPONSIBILITIES

• Initiates Medicaid application process for potential participants, including application completion, assisting applicants with gathering and processing verification items, application submission, and coordination with county case managers, tracking and follow-up of application status
• Provides initial telephone point of contact with potential participants and participants’ family/care giver and referral sources as needed
• Completing home visits as necessary to aid in this process
• Conducts consistent professional written and verbal communication with referral sources, and documents these communications in the Electronic Health Record
• Requests and tracks requests for records and other required paperwork from doctors’ offices, and other sources as needed
• Maintains Medicaid Tracking database including tracking time to approval from submission to MD Health Department to approval by MD Health Department
• Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format
• Prepares forms from MDHD and tracks the participant’s recertification (RRR) with MDHD to make sure they are approved year to year
• Supports Edenbridge PACE finance department in validation of Medicaid payments and revenue cycle as needed and requested by the Finance Dept.
• Completes and records initial and annual verifications of participants’ incomes. 
• Maintains and updates participant shared payments for Assisted Living Facilities (ALF)
• Coordinates intake of new participants as necessary
• Maintains professional affiliations and any required certifications.
• Performs other duties as assigned

QUALIFICATIONS
Experience:

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of MD DHS, Medicaid, and Social Security processes
• Extensive knowledge of community resources available to seniors and their families
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• 1 year experience working with the frail and/or elderly populations required
• Experience working with an Electronic Health Record preferred
• Must submit to and pass a pre-employment drug/alcohol screening and criminal background check 
• Must have a current driver’s license and driving record must be in compliance with company policy.
• Operates in full compliance with all applicable federal, state and local fire, health, safety, sanitation, Emergency procedures and other Standards prescribed in law or regulations 

Interested candidates please apply by submitting your resume at https://edenbridgehealth.applytojob.com/