Regional Medicaid Specialist

at  Aspire Health Group

ASPIRE HEALTH GROUP IS LOOKING FOR A QUALIFIED REGIONAL MEDICAID SPECIALIST TO JOIN OUR FAMILY!

We are searching for a Regional Medicaid Specialist to join our community that is employee focused, a team builder, and excited about the opportunity to assist in building a facility culture.
We are flexablie with travel requirements!

EDUCATION

• Must possess, as a minimum, a high school diploma or its equivalent, two-year degree preferred.
• Computer literacy skills (Microsoft Outlook, Microsoft Office, Internet).

• Three to Five years of professional experience and/or training; or equivalent combination of education and experience.

  Experience

• Must have 3 years’ experience as one of the following: 1) Skilled Nursing Medicaid billing & eligibility screening or 2) Social Worker with Skilled Nursing Medicaid eligibility processing experience or 3) Other role serving as a Skilled Nursing Medicaid eligibility liaison with Skilled Nursing Medicaid eligibility processing experience.

• Must have experience with Excel and Microsoft Office programs.

• Must possess knowledge of and demonstrated skill with the pertinent billing software.

  Specific Requirements

• Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

• Knowledge of principles and processes for providing customer services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Must possess the ability to prioritize duties and responsibilities.
• Must be knowledgeable of computer systems, system applications, and other office equipment.
• Effective verbal and communication skills
• Understanding written sentences and paragraphs in work related documents.
• Actively looking for ways to help people.
• Communicating effectively in writing as appropriate for the needs of the audience.
• The ability to read and understand information and ideas presented in writing.

Educate Care Center and regional interdisciplinary team on pending protocol and state/federal updates.
Train Care Center and regional teams on their roles and responsibilities on the application process, policy, and procedure, and pending initiative.
Assess/Review trend reports, pending initiative implementation, opportunity for application needs on rolling Private (PVT) Primary, Private (PVT) COINS Part A Still In House (SIH). Review cause of non-payment for rolling Resident Liability.
Support/Guide assigned Care Centers throughout entire pending process/protocol.
Communicate/Reporting to Care Center, regional, and divisional interdisciplinary teams. Care Center Visit Reports on each visit, quarterly review reports each quarter.
Advise on referrals pre-admit, disability cases, Red Flag Cases, plans to improve, need of outside resources.
Manage trends of pending and pending denied attached to Key Performance Indicators (KPI) benchmarks.
Development of improvement plans with input/involvement from both care center and regional teams.
1. Responsible for the oversight and success of the pending Medicaid application process for a group of assigned Care Centers.
2. Educate Care Center staff regarding the pending Medicaid application process, including identification of all
pending/recertification files, incomplete 3008 forms, timely completion of PASRR II assessments, citizenship issues, unsigned
documents, missing financial information, evaluation of income & asset levels for potential admissions and residents who’ve already admitted.
3. Provide guidance to Care Center staff in determining appropriate actions needed to resolve applicant status if ineligible.
4. Assess high risk direct admit Non-Payer - Medicaid Pending with Executive Directors and Admission Directors through the preadmission screening process.
5. Assist with all levels of Disability application processes including assistance with web-based application and phone interviews.
6. Ensure effective processes are in place at the Care Centers for processing Pending Medicaid application, recertification
documentation and tracking the status of open pending Medicaid applications.
7. Troubleshoot previously denied files including obtaining previously unattained documentation, including advising on appeal
processes and time restraints attached to appeal limits per state protocol, review denials to capture opportunity to file for medical allowance.
8. Communicate with government agencies when needed.
9. Attend State sponsored seminars/trainings associated with the Skilled Nursing Facility Pending Medicaid processes; communicate
and educate at the Care Center level.
10. Stay abreast of State updates to Skilled Nursing Pending Medicaid updates-communicate and educate to the Care Center level.
11. Determine and discuss the need for Medicaid service companies/attorney offices to address income levels, asset levels, Qualified
Income Trust needs and Guardianship needs.
12. Recommend to Care Centers when a Final Request to Comply with Financial Obligation letter should be considered to any resident or designated representative that is non-compliant with the submission of documentation needed to complete the Medicaid application process as required by Department of Children and Families, Social Security Administration, and other regulatory agencies.
13. Identify underlying issues with Medicaid Pending policies and procedures on a Care Center level. Develop and implement training on procedures and provide support to Medicaid designated staff to streamline the application to eligibility process.
14. Determining the best course of action to resolve issues in both the pending Medicaid files as well as recertification issues.
15. Analyze the status of all Medicaid pending account balances and develop strategies for resolution of outstanding balances. Be directly involved in Red Flag accounts, focus on accessing all cases over 60 days to determine root cause of delay-advise on how to remove that barrier and follow through to ensure directives were followed to ensure risk of denial is removed. This may require the Medicaid Specialist to be directly involved in completing the task with the Care Center.
16. Each Care Center visit will require a Care Center Visit report that will outline action plans to resolve outstanding Medicaid pending balances.