Medicaid Specialist Field Staff

TITLE:

Medicaid Specialist Field Staff

REPORTS TO:

Operations Admissions Coordinator

The Medicaid Specialist Field Staff is responsible for overseeing and executing the Medicaid application process for residents, ensuring compliance with eligibility criteria, and documentation standards. This role meets with residents and their families in-person or virtually to obtain, verify, and submit complete and accurate Medicaid applications within required time frames. The Medicaid Specialist Field Staff serves as the main point of contact throughout the public aid application process and maintains ownership of the application from initiation through submission, mitigating risk of delays, denials, or non-payment by ensuring adherence to existing guidelines, and facility protocols.

• Bachelor’s degree in a related field or demonstrated experience with the Medicaid application process or related work, required.
• Must have advanced working knowledge of the Illinois Public Aid system. Working knowledge of the Wisconsin Public Aid system is preferred.
• Experience working in long-term care and a working knowledge of related benefit/eligibility portals is preferred.
• Communicates appropriately, is adaptable to changes in assignments and priorities.
• Must be able to travel to Alden facilities and work on-site Monday through Friday. Remote work is not available for this role.
• Must be able to read, write, and speak the English language in an understandable manner.
• Must have the ability to make independent decisions when circumstances warrant such actions.
• Must possess the ability to deal tactfully with families, residents, visitors, personnel, regulatory agencies, and the general public.
• Must possess patience, tact, a cheerful disposition, and enthusiasm.
• Must have proficiency using computers and standard office software such as Microsoft Excel, Microsoft Outlook, and EMR systems and possesses the ability to learn new software systems as needed.

• Must be able to move intermittently throughout the workday.
• Must be able to cope with the mental and emotional stress of the position.
• Must possess sight/ hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
• Must being good general health and demonstrate emotional stability.
• Must be able to relate well and work with the ill, disabled, elderly, emotionally upset and at times hostile people within the facility.
• Prolonged standing/walking is required.
• May be required to lift, push, pull, and move equipment, supplies, etc., throughout the day.
• Is subject to exposure to infectious waste, diseases, conditions, etc., including exposure to the (HIV) AIDS and Hepatitis B viruses.

• Prior to admission, contact public aid pending residents and/or their responsible party to obtain necessary information, documents, forms, and financial information needed to initiate the Public Aid (i.e. Social Security award letters, pension information, bank statements, etc.).
• Monitor PCC daily for respective facilities to identify payer changes and to identify residents who need to apply for Medicaid.
• Contact the resident and/or responsible party within 48 hours of admission, or within 48 hours of being notified of a payer status change to inform them of their financial responsibilities and complete the Income Due Alden Form (if necessary), 2998 and 3654 and to discuss the Medicaid qualifications and document requirements. Provide a copy of the public aid checklist and explain the checklist in detail to ensure understanding of their financial responsibilities.
• Contact the resident and/or responsible party weekly (every 5 days) to assist in gathering necessary documentation (i.e. bank statements, social security, pension, etc.) and review provided documentation for accuracy upon receipt. Continue to follow up weekly (every 5 days) until the public aid application is completed, submitted, and accepted.
• If unable to contact a resident or their responsible party after consistent attempts for a period of two weeks, elevate the situation by scheduling a meeting with the facility Administrator, Admission Director and Social Service Director to review the case and discuss potential guardianship needs.
• Maintain accurate documentation in EMR or related system regarding the progress and status of the application process and detailed documentation of all follow up communication with the resident…