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Medicaid Coordinator

Medicaid Coordinator

Job ID 
2017-1430
# of Openings 
1
Job Locations 
US-NE-Omaha
Posted Date 
8/23/2017
Category 
PACE Pathways

More information about this job

Overview

The purpose of this job is to ensure that participants receive and maintain their Medicaid eligibility, which includes tracking and processing reviews/renewals annually. Responsibilities include assisting current participants in maintaining Medicaid benefits through the yearly review/renewal. This person will also be responsible for library administrator duties utilizing document management software for new, edits, and annual audits of policies for Immanuel Pathways. Responsible for working with Accounting and Executive Directors in notification and follow up for Share of Cost, Client Participation, and Room and Board per state Medicaid notification. Supports and lives out Immanuel’s Mission and CHRIST’S Promises.

Responsibilities

Approx. Time Requirement

Key (Essential) Functions of this Job

70% Medicaid Eligibility Processes

  • Reviews Medicaid eligibility, monitors time frame for review/renewal and takes necessary steps to complete review/renewals to prevent Medicaid closure.
  • Educates participants on the Medicaid application, review/renewal process and general rules/regulations.        
  • Assists participant with gathering financial documentation.
  • Establishes and maintains relationships with state Medicaid resources.
  • Identify and explain Medicaid issues to participants and coordinates resolutions, if applicable.
  • Effectively communicates with Income Maintenance workers in the State of Iowa and the Social Service Worker in the State of Nebraska, regarding Medicaid.
  • Maintain knowledge of current and emerging information regarding Immanuel Pathways, Medicaid, Medicaid legislation, regulations, and trends and disseminate and educate Immanuel Pathways managers and staff.
  • Assists in developing procedures and define and improve best practices regarding Medicaid eligibility for Immanuel Pathway Center participants.
  • Participates in quarterly meetings with State Administrating Agency and Immanuel Pathway Centers, or as needed.
  • Maintains Medicaid tracking through software system to ensure timely review/renewals of Medicaid for no case closure.
  • Provides complete documentation within software system regarding Medicaid, i.e. uploaded documents, narration of discussions, and updated review/renewal dates.
  • Collaborates with Accounting and Executive Director regarding past due Share of Cost, Client Participation, and Room & Board.
  • Creates pending disenrollment letter/involuntary disenrollment to be executed and followed up by the Executive Director.
  • Assists with participant and authorized representative discussions regarding Medicaid Eligibility, Share of Cost, Client Participation, Room and Board, and past due processes as requested by the Executive Director.
  • Provides timely communication of Medicaid status change to Immanuel Pathway Centers, Accounting, and Risk Adjustment Supervisor.
  • Travels to Immanuel Pathway Centers in Iowa/Nebraska to complete job responsibilities on a monthly or as needed basis.
  • In Nebraska, will establish a calendar for contact with the assigned Social Worker during the first week of the month and on the 2nd to last working day of the month regarding new enrollees and disenrollments.
  • Provides guidance to Immanuel Pathway Centers regarding Medicaid eligibility, including challenges requiring innovative solutions and education.

20% Library Administrator

  • Utilizes document management software for annual policy audit, policy edits, and new policies.
  • Completes audits, edits, and creation of forms and standard operating procedures outside of document management software, until the time this system manages all library items.

10% Other

  • Collects data and prepares reports at the direction of the Director of PACE Operations.
  • Participates and supports the Quality Improvement Initiatives.
  • Practices Universal Precautions and follows appropriate infection control procedures.
  • Protects privacy and maintains confidentiality of all company procedures, results, and information about employees, participants, and families.
  • Performs related duties as required or requested.

Qualifications

Education-

  • Some college is required.
  • Bachelor’s Degree in Business, Accounting/Finance, Marketing, Social Work or a related field is preferred.
  • Equivalent years of experience may substitute for education requirement.

 

 

Experience-

  • Two (2) years of experience in assisting individuals who are applying for Medicaid or other governmental programs is required.
  • One (1) year of experience working with a frail or elderly population required.
  • Experience in healthcare setting is desirable.

Other Requirements-

  • Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
  • Must have a valid driver’s license, proof of insurance and have means of reliable transportation for driving to Immanuel Pathway Center locations.
  • Speaking and interpreting different languages is desirable.

 

KSA- Knowledge Skills and Abilities-

  • Knowledge of Medicaid regulations, processes and procedures.
  • Knowledge of or the ability to learn the PACE philosophy and eligibility/denial criteria.
  • Knowledge of financing mechanisms such as Medicaid, Medicare, Prospective Payment systems, and Health Maintenance Organizations or other managed care systems providing risk-based capitated ratesKnowledge of computer applications including Outlook, Word, Excel, data base software.
  • Ability to meet deadlines, complete projects, and manage multiple tasks.
  • Ability to follow naming conventions and practices as established.
  • Skills in organizing time and prioritizing duties.
  • Skills in effective written and verbal communication.
  • Skills in establishing and maintaining effective working relationships with participants, co-workers, and the public.
  • Skills in follow-up and follow through with people and appointments.
  • Ability to project professionalism, approachability, and genuine interest to various audiences.
  • Ability to work independently with minimum supervision.
  • Ability to identify roadblocks and offer solutions.
  • Ability to work under deadline situations.
  • Ability to work within various software and document management systems.
  • Able to offer feedback and positively resolve conflict.
  • Ability to internalize and apply feedback from manager/supervisor to improve performance and minimize errors.

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