Medicaid Specialist

Position Summary:

The primary purpose of this position is to process all Medicaid Pending Applications through approval, process and track Re-Determination. This position is also responsible for booking and collecting estimated PPA on pending residents.

Upon approval Medicaid Specialist will update census and payor tree. Bill all retro PPA changes as per budget letter. Work with responsible parties and DSS on all PPA and eligibility date discrepancies.

Bill and follow through on all Medicaid Payors per billing calendar. Bill and follow through on monthly PPA.

Recommended Minimum Position Qualifications

• 3 years of experience in skilled nursing (SNF) / LTC business office
• PointClickCare experience preferred
• Long Term Medicaid Eligibility Requirements and Medicaid billing experience required
• Able to prioritize and organize tasks at hand to meet specific deadlines.
• Able to work with a diverse group of people.

Essential Duties and Responsibilities

1. The Specialist will be responsible for working with Admissions, Business Office staff, and Case Management to identify potential applicants in need of Medicaid coverage.

a. Specialist will work with applicants to complete all new Long Term Care applications with supplemental forms

• Work with residents, responsible parties, POAs and Attorneys to secure documentation needed for screening review and eligibility requirements.

c. Identify issues that will delay or deny resident approval

2. Confirm all Maximus/Assessment Pro and LOC are current and accurate. Verify that all state specific documentation is current.

3. The Specialist will be responsible to monitor and follow up on all pending, approved, denied, and appealed applications as needed to ensure proper coverage is obtained.

4. Specialist will complete the monthly Medicaid Pending Log to reflect status of applications and review denied or delayed claims with AR team.

5. All other duties as assigned.

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