NURSING HOME MEDICAID PENDING SPECIALIST

Description

Priority Management Group

Priority Management Group’s vision is to be the preferred provider of care and employer of choice by exceeding the expectations of our residents and their families, creating an exceptional work environment for our staff and promoting excellence in our quality of services provided. We are looking for a full-time Nursing Home Medicaid Pending Specialist to be a part of our incredible team and who has the same vision.

Position Summary:

The Medicaid Pending Specialist is a key and visible team member working on special projects to assist the Business Office team with processing potential Medicaid patients for previous, current and future Medicaid eligible recipients. In the most expedient manor possible to ensure compliance and efficiency on outstanding balances over (90) days. Position identifies best practices and implements processes that continually improve systems to achieve superior outcomes, with a goal to reduce Medicaid Pending’s outstanding days and reduce loss revenue. The position will be monitored based upon the task at hand. Local and some over-night travel is required.

Benefits Include:

• Medical
• Dental
• Vision
• Basic Company Paid Life insurance
• Long Term Disability
• Voluntary Life Insurance for the Employee, Employee Spouse and Employee Children
• Short Term Disability, Cancer, Critical Illness, Accidental and Universal Life
• Tuition Reimbursement
• Paid Time Off

Qualifications

Specific Requirements include:

• Must have previous experience working at a Skilled Nursing Facility or have previously held similar position
• Minimum of three years relevant Medicaid experience
• Associates Degree in Business or Accounting fields; Bachelor’s degree preferred
• Must have excellent communication skills with all team members, as well as spreadsheet skills
• Must be able to comprehend in-depth knowledge of Medicaid eligibility requirements
• Review Financial Determination Form to determine patient financial needs
• Review and resolve eligibility requirements, i.e.: need for QIT, Estimated Applied Income, Life Insurance policies, etc.
• Work with patients and families to retrieve and gather necessary documentation to accompany the Medicaid application
• Submit and assist family with Medicaid application to ensure in within 30 days
• Educate/advocate/communicate with all necessary parties including Medicaid Offices and 211 during the pending process
• Create and keep a tracker of intake appointments, status and cases approved and next steps
• Create and maintain electronic records and documentation of pending cases on the facility shared drive
• Create and maintain weekly Pending Logs for updated status of applications
• Work directly with Business Office staff and LSW to file appeals as necessary for approvals
• Ensure annual recertifications are completed timely
• Must be able to read, write, speak, and understand the English language
• Must possess the ability to make independent decisions when circumstances warrant such action.

Priority Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.