Medicaid Eligibility Specialist

Summary

Responsibilities include but are not limited to:Review and approve all Medical Eligibility Applications prior to submission.Review, approve, and submit every Medicaid Financial Eligibility Application and attached documentation for assigned SNFs.Proactively contact County representative for assigned SNFs to assure applications are progressing and expedite requests for additional information in advance of formal notice.Interface with customer or representative to secure new grants (from County submission until Grant Approval) and to maintain grant status (Eligibility Re-Determinations).Determine response to Grant Discontinuation and/or Denials. Lead response, which may include Appeal, Re-Application, or Acceptance.Recommend legal or outsourced services to Administrator. May liaise on behalf of SNF.Communicate billing requirements to SNF based on Grant Approval or Denial, e.g. Retro-adjustments, Write-off, Adjustments.Monitor SNF activity for potential applications, new applications, pending applications (with A/R balances), approved applications, appealed applications, and re-determination of continuous eligibility application.Work with SNF to mitigate NSHC financial risk associated with Uncooperative Customers, Process Breakdown, and Administrator Escalations.Required Qualifications and Skills:College degree preferred with a minimum of 5-7 years experience in Long Term Care /Healthcare industry or equivalent experience in County Agency.Accounting, Insurance, Paralegal experience may be transferable.Proficient in state specific Medicaid Eligibility Requirements & Application Process.Proficient in review of Medicaid Applications.Time and Priority ManagementAbility to travel to multi-sites within an identified region.We offer competitive compensation and benefit plans including:Vacation, sick and holiday payST/LT Disability InsuranceTuition ReimbursementLife Insurance401KWe embrace diversity and are committed to fostering an inclusive workplace for all employees.Next Step Healthcare is an Equal Opportunity / Aff…All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin.#J-18808-Ljbffr

Job Description

Responsibilities include but are not limited to:Review and approve all Medical Eligibility Applications prior to submission.Review, approve, and submit every Medicaid Financial Eligibility Application and attached documentation for assigned SNFs.Proactively contact County representative for assigned SNFs to assure applications are progressing and expedite requests for additional information in advance of formal notice.Interface with customer or representative to secure new grants (from County submission until Grant Approval) and to maintain grant status (Eligibility Re-Determinations).Determine response to Grant Discontinuation and/or Denials. Lead response, which may include Appeal, Re-Application, or Acceptance.Recommend legal or outsourced services to Administrator. May liaise on behalf of SNF.Communicate billing requirements to SNF based on Grant Approval or Denial, e.g. Retro-adjustments, Write-off, Adjustments.Monitor SNF activity for potential applications, new applications, pending applications (with A/R balances), approved applications, appealed applications, and re-determination of continuous eligibility application.Work with SNF to mitigate NSHC financial risk associated with Uncooperative Customers, Process Breakdown, and Administrator Escalations.Required Qualifications and Skills:College degree preferred with a minimum of 5-7 years experience in Long Term Care /Healthcare industry or equivalent experience in County Agency.Accounting, Insurance, Paralegal experience may be transferable.Proficient in state specific Medicaid Eligibility Requirements & Application Process.Proficient in review of Medicaid Applications.Time and Priority ManagementAbility to travel to multi-sites within an identified region.We offer competitive compensation and benefit plans including:Vacation, sick and holiday payST/LT Disability InsuranceTuition ReimbursementLife Insurance401KWe embrace diversity and are committed to fostering an inclusive workplace for all employees.Next Step Healthcare is an Equal Opportunity / Aff…All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin.#J-18808-Ljbffr