Medicaid Specialist TCOOMMI

Duties And Responsibilities

• Answers phone, greets customers, and schedules patient appointments.
• Obtains medical records from the Outpatient Clinics and submits them to Social Security Administration, DDS, or ODAR.
• Requests necessary information to determine eligibility, including completing the Screening for SSA and Medicaid Eligibility Assessment.
• Ensures all state requirements are met and secures all required documentation.
• Processes Medicaid claims through the Community Partnership with HHSC.
• Enrolls clients in Affordable Healthcare Insurance.
• Maintains confidentiality of all business matters.
• Processes monthly reports for the consumers served.
• Performs monthly follow-up calls for SSA case status and documents per program guidelines in electronic health records and TDCJ database, where applicable.
• Aids assigned clients in completing ADL's and Work History Reports within 2 weeks of receipt, as needed/applicable.
• Serves as a backup to the Lead Medicaid Specialist.
• Processes all initial and follow-up claims for the clients at their assigned units, as applicable.
• Completes correspondence for consumer's medical requests (SSA correspondence, etc.), as needed or applicable.
• Confirms the Consultative Exams their assigned clients have pending and reports to DDS that the clients will attend the consultative examination, as needed/applicable.
• Maintains compliance with all Joint Commission training requirements relevant to job, those dealing with use of restraints and physical holding of individuals receiving services.
• Performs other duties as assigned.

Minimum Education And Experience Requirements

• High School diploma or GED supplemented by two (2) years of experience working with claims processing, insurance, office administration or related field; or equivalent combination of education, training, and experience which provides the required knowledge, skills, and abilities.
• Experience with trauma-informed services; cognitive behavioral therapies, including Dialectical Behavioral Therapy (DBT); and motivational therapies including the use of incentives, preferred.

Required Knowledge And Abilities

• Knowledge of trauma-informed theories, principals, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

• Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.
• Routine and frequent exposure to: Bright/dim light; Dusts and pollen; Extreme heat and/or cold; Wet or humid conditions; Extreme noise levels, Animals/wildlife; Vibration; Fumes and/or noxious odors; Traffic; Moving machinery; Electrical shock; Heights; Radiation; Disease/pathogens.
• Involves unavoidable hazards (Work Environment) involving routine and frequent exposure to: Bright/dim light; Dusts and pollen; Extreme heat and/or cold; Wet or humid conditions; Extreme noise levels, Animals/wildlife; Vibration; Fumes and/or noxious odors; Traffic; Moving machinery; Electrical shock; Heights; Radiation; Disease/pathogens; Toxic/caustic chemicals; Explosives; Violence.