Medicaid Specialist

DUTIES AND KEY RESPONSIBILITIES: Interpret and apply New Jersey Medicaid regulations, policies, and guidelines, including billing requirements for Managed Care Organizations (MCOs), Medicaid redeterminations, and MCO reauthorizations, to ensure compliance with program requirements.Collaborate with responsible parties (RPs)/families to review patient eligibility requirements for New Jersey Medicaid coverage and advise in the enrollment process, including enrollment in the appropriate MCO.Work with NJ community Directors to obtain pertinent information in regard to PAS requests including but not limited to PA4 and AL6, MCO authorizations and reauthorizations.Coordinate with outside Medicaid specialists and/or eldercare legal teams to provide needed information to expedite the eligibility process.Verify and accurately complete New Jersey Medicaid claims forms for billing to MCOs, ensuring adherence to documentation requirements and timely submission.Conduct thorough reviews of medical records and treatment plans to determine appropriate New Jersey Medicaid billing codes, including codes for MCO billing, and ensure accurate reimbursement.Facilitate the billing process to Managed Care Organizations (MCOs) by coordinating with healthcare providers, submitting claims, and resolving any billing discrepancies or errors.Assist with ALP billing at other communities (NY) as directed by VPO.Follow up with Medicaid or MCOs in regard to denied or partially paid claims.Assist in Medicaid redetermination processes by confirming upcoming deadlines and processes with RPs.Collaborate with MCOs to facilitate the reauthorization process for continued care, coordinating with healthcare providers and patients to gather required information, submitting reauthorization requests, and tracking their status.Stay updated on changes in New Jersey Medicaid regulations, policies, and procedures, including updates related to billing to MCOs, Medicaid redeterminations, and MCO reauthorizations, and communicate relevant updates to the appropriate stakeholders.Assist patients in understanding New Jersey Medicaid benefits, coverage limitations, the claims process, and their responsibilities for redeterminations and reauthorizations.Assist residents and families with the Medicaid renewal process and obtaining proper renewal documents.Respond to inquiries from patients, healthcare providers, MCOs, and insurance companies regarding New Jersey Medicaid-related matters, including billing to MCOs, redeterminations, and reauthorizations.Update residents’ profiles in Point Click Care to reflect Medicaid as primary insurance and share updates with all pertinent parties within the community.Conduct internal audits to identify and rectify potential compliance issues specific to New Jersey Medicaid, particularly those related to MCO billing, redeterminations, and reauthorizations, suggesting process improvements where necessary.Provide training and education to healthcare staff regarding New Jersey Medicaid billing, coding, documentation requirements, and the processes related to MCO billing, redeterminations, and reauthorizations. QUALIFICATIONS:Bachelor's degree in healthcare administration, business administration, or a related field (relevant work experience can be considered in lieu of a degree).At least 3-5 years of accounts receivable experience.Multi-site/Multi-company or multi-state corporate accounting/finance experience a mustHealthcare industry or rental property experience a plusIn-depth knowledge of New Jersey Medicaid regulations, policies, and guidelines, including requirements for billing to Managed Care Organizations (MCOs), Medicaid redeterminations, and MCO reauthorizations.Familiarity with medical billing and coding practices, including understanding of ICD-10 and CPT codes, particularly those related to MCO billing.Strong analytical skills and attention to detail to accurately review and process New Jersey Medicaid claims, specifically those related to MCO billing, redeterminations, and reauthorizations.Excellent communication and interpersonal skills