Eligibility & Financial Redetermination Lead

Responsibilities

• Provide exceptional customer service to participants and their representatives
• Coordinate all aspects of the annual redetermination process for Medicaid, including obtaining and collecting all necessary documentation to maintain ongoing eligibility
• Train new staff on the Redetermination team and provide support in the absence of the Eligibility and Financial Redetermination Supervisor
• Complete all re-determinations for assigned caseload on or before the required due date via home visits or day center visits
• Assist participants/families/POA with obtaining, compiling, and collecting all necessary paperwork and documentation to maintain Medicaid eligibility
• Track and document all performed tasks via case notes in the participant's record; ensure all documents are scanned and indexed into the appropriate database
• Organize caseload and working area efficiently to allow information access when unavailable
• Interpret and communicate rules and regulations of Long-Term Medicaid, Spousal Impoverishment, and Trusts to participants and families/POA in an easily understood manner
• Work closely with county technicians to respond to notices or adverse actions
• Provide immediate attention to new cases on the Aging Report and advise supervisor of disenrollment notices that need to be sent
• Complete supportive housing forms as needed; request and follow through on county transfers; update county on participant moves and ensure address changes are completed
• Complete disenrollment forms and submit to county technician as required
• Assist with problem cases, troubleshooting, and offering training and guidance
• Serve as backup for Eligibility and Financial Redetermination Representatives as needed, including when representatives are behind or on leave
• Demonstrate deeper Long-Term Care Medicaid knowledge and share knowledge with staff; demonstrate superior knowledge in all areas of the Medicaid Redetermination process
• Assist Supervisor and Manager with staff training
• Commit to the quality improvement process and continuous improvement philosophy; identify and respond actively and with sensitivity to needs; participate as a team player; remain open and responsive to change
• Communicate and interact professionally; maintain strict confidentiality of personnel data, proprietary information, and sensitive materials
• Maximize cost efficiency and productivity in use of department and organization resources
• Attend all required department events, staff meetings, and job-related functions; complete all mandatory trainings
• Do not communicate with news media or volunteer business information to other agencies; direct public relations issues appropriately
• Do not enter contracts without approval; perform within position and personal limitations

Requirements

• High School diploma or GED required
• Minimum of three years' total experience
• Current knowledge of the Medicaid system/benefits and community resources available to seniors and families
• Minimum of two years working with the frail or elderly required
• Valid state-issued driver's license, personal transportation, good driving record, and auto insurance as required by law
• Ability to establish and maintain cooperative and positive working relationships
• Organized, detail-oriented, courteous, proactive, self-motivated, dependable, and excellent customer service skills
• Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment
• Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds

Qualifications

• Minimum of 5 years working in the Long-Term Care Medicaid Field
• Strong problem-solving skills
• Strong interpersonal and verbal communication skills
• Proven track record of handling difficult situations with diplomacy and professionalism
• Exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge
• Ability to read and write memos, reports, and correspondence that conform to prescribed style and format

Pay

Posted pay range: $52,000–$65,000

Benefits

• Medical, dental, and vision insurance
• Short and long-term disability
• Life insurance and AD&D
• Supplemental life insurance
• Flexible spending accounts
• 401(k) savings plan with company match
• Paid time off
• Company-paid holidays