Medicaid Specialist Field Staff

About the role

The Medicaid Specialist Field Staff oversees and executes 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 timeframes.

Responsibilities

• 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, escalate 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 and/or their responsible party.
• Once all documentation is obtained, complete and submit the Application for Benefit Eligibility (ABE) using information provided by the resident and/or their responsible party, ensure a copy of submitted application is uploaded to the EMR, and monitor the application status by checking the eligibility portal (One Source or Medi) on a weekly basis.
• Once submitted, notify the PA Coordinator via email.
• If an asset spenddown is necessary, guide the resident and/or their responsible party in spending money appropriately.
• Respond to all DHS requests and gather additional information as necessary.
• Communicate regularly with the facility for updates on Notices of Decision.
• Review approval letters for accuracy and upload to EMR.
• Review denials and file an appeal within 60 days from the date of the denial notice.
• Attend telephonic appeal meetings and present the case to the Bureau of Hearings.
• Assist with the Medicaid Redetermination process by communicating with residents and/or their responsibly parties to obtain documents needed to successfully complete the REDE for active residents.
• Work with resident and/or their responsibly party to collect and review all documents requested by OIG for pending cases and submit requested documentation in a timely manner.

Qualifications

• 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.
• 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 posses the ability to learn new software systems as needed.