Billing Specialist

Job Summary

The Medicaid Specialist will help determine client eligibility for financial assistance through the Medicaid program through interactive interviewing and fact gathering for all out of state referrals with either no primary payor or special needs which will convert to Medicaid long-term care. This role is assigned to focus on referrals originating from outside the state as well as any in-state difficulty, Medicaid Pending cases and pending cases lacking a Business Office Manager. The Medicaid Specialist works collaboratively with the Centralized Admission Intake and Business Development teams on the financial review of referrals.

Major Duties and Responsibilities

• File Medicaid applications for benefits according to State and Federal guidelines for all new admissions admitting Medicaid Pending as a primary for all out of state primary and /or as a secondary Medicaid pending payors.
• Aid in filing Medicaid applications for admissions admitting Medicaid Pending or anyone transitioning to Medicaid Pending at designated facilities with no available Business Office Manager.
• Interview and discuss Medicaid process with applicants and/or responsible parties to determine eligibility status. This may be done collaboratively with the admissions and business office in the facility.
• Review Medicaid checklist with out of state applicants and/or responsible parties to determine eligibility of an approval or denial. This also applies to any in-state cases assigned in the absence of a business office manager, as assigned.

Required Education and Experience

• A High School Diploma or GED, some college coursework preferred.
• At least 3-5 years of experience compiling documentation and submitting Medicaid applications on behalf of long-term care facility.
• Must be computer literate and proficient in Microsoft Office, Excel and Word.
• Knowledge of PCC.
• Strong written, verbal, and interpersonal communication skills.
• Very detailed and organized.