Job Title: Medicaid Specialist

Reports to: Edenbridge Health & Edenbridge PACE

Status: Non-Exempt

Location: Edenbridge PACE at Skyland Town Center, 2211 Town Center Dr, SE Washington, DC 20020

JOB SUMMARY

Under the direction of Edenbridge Health and in cooperation with the PACE Executive Director, this position is responsible for establishing and maintaining Medicaid and long-term care eligibility for PACE participants. This includes: preparation and submission of potential participant Medicaid applications, tracking and processing redeterminations for participants, assisting in the level of care assessment coordination process, and serving as a PACE liaison to DHCF, case managers, and other stakeholders to expedite the application and enrollment process.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Initiates and completes Medicaid application process for potential participants, including preparing applications, assisting applicants with gathering and processing verification items, application submission, coordination with DHCF and case managers, and tracking and following up on application status.
• Provides initial telephone point of contact with potential participants and participants’ family/caregiver and referral sources as needed.
• Completes home visits as necessary to finalize applications and gather materials where necessary.
• Conducts consistent professional written and verbal communication with DHCF personnel, case managers, referral sources, and partners 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 DHCF to approval by DHCF.
• 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 DHCF and tracks the participant’s recertification with DHCF to make sure they are approved year to year.
• Supports PACE4DC, LLC (d/b/a Edenbridge PACE) finance department in the validation of Medicaid payments and revenue cycle as needed and requested.
• 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.
• Participates in team meetings and supports members of the outreach and enrollment team.
• 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 Medicaid eligibility, Medicare, and Social Security processes strongly preferred.
• Experience working with DHCF long-term care or with a frail elderly population is preferred but not required.
• 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.
• Experience working with an Electronic Health Record is 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.

Please visit our website at www.edenbridgehealh.org