Medicaid Specialist​/Collections Specialist

General

Purpose:

The Medicaid Specialist acts as a liaison between patients, skilled nursing facility, and government agencies, ensuring that residents receive the benefits they are entitled to and that applications are processed efficiently and accurately.

This facility expects their employees to promote an atmosphere of teamwork with other employees, hospitality, and comfort for its residents. Therefore, the following list of duties is not all-inclusive:

• Prepare and submit reports on a timely basis as required and directed by Business Office manager,Administrator, this company and governmental agencies.
• Secures documentation for Medicaid/MSP new applications and renewal applications if needed for members’attention to detail by adhering to state requirements and securing supporting documentation.
• Collaborates with government offices to accurately complete the application and recertifi-cation process.
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by en- suring proper phone etiquette and adherence to scripts, state regulations, HIPAA compli-ance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation.
• Review financial statements, check personal information, and analyze eligibility requirements.
• Contact Medicaid with problems of recertification and budget determinations.
• Accumulate and maintain, in an organized manner, vital statistics relating to admissions,discharges, deaths, transfers and daily censusof facility residents.
• Bill Medicaid claims weekly.
• Responsible for weekly Medicaid billings along with timely follow-up with intermediaries on delinquent payments.
• Monitor and manage the accounts receivable collection process.
• Pursue past due accounts persistently and maintain proper back-up documentation
• Obtain and submit all required documentation to bill third party payers as per program/company guidelines.
• Verify that resident trust is accurately recorded.
• Provide statistics to audit and reimbursement for year-end
  • processing.
• Maintain an accurate accounting of patient trust funds including monthly reconciliation and quarterly statements to responsible parties. Reconcile petty cash for Patient Trust Funddaily.
• Participate in the resident admission process by providing explanations of the facility’srates, billing cycle and payment terms, including collecting the first month’s advance payment upon admission.

• Attend in-service education programs in order to meet facility educational requirements.
• Be familiar with Standard Precautions, Exposure Control Plan, Fire Drill and Evacuation Procedures and know how to use the information.
• Maintain confidentiality of resident and facility records/information.
• Protect residents from neglect, mistreatment, and abuse.
• Others as directed by the supervisor or administrator.

• Business Degree or experience in health care facility; office management preferred.
• Organized and detailed in work performance.
• Good communication skills with excellent self-discipline and patience.
• Genuine caring for and interest in elderly and disabled people in a nursing facility.
• Comply with the Residents’Rights and Facility Policies and Procedures.
• Perform work tasks within the physical demand requirements as outlined below.
• Perform Essential Duties as outlined above.