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Years of Experience
Date Last Verified
ProfileManager - Regional Medicaid Eligibility The candidate handles customer portfolio spanning multiple SNF's across Counties within the region by: presenting a comprehensive and inclusive Financial Eligibility Application (accompanied by Medical Assessment Progress) for submission and approval to County to secure grants at first pass and within 30 days of submission, and minimize coverage gaps (Requested effective date of coverage matches Grant Effective Date) and responding to Grant Decisions including re-determinations through either Acceptance or Appeal Process. Will liaise with County, SNF and customer or representative to secure and maintain grant from time of submission to county through initial grant decisions and ongoing eligibility determinations. May act as company Representative at state level to affect change. Participate in professional associations and internal forums. Review and approve all Medical Eligibility Application prior to submission. Review, approve, and submit every Medicaid Financial Eligibility Application and attached documentation for assigned SNFs. Contact County representative for assigned SNFs to assure applications are progressing and expedite requests for additional information in advance of formal notice. Interface with customer or representative to secure new grants (from county submission until grant approval) and to maintain grant status (eligibility re-determinations). Determine response to Grant Discontinuation and/or Denials. Lead response, which may include appeal, re-application, or acceptance. Recommend legal or outsourced services to Administrator. May liaise on behalf of SNF. Communicate billing requirements to SNF based on Grant Approval or Denial, e.g. retro-adjustments, write-off, adjustments. Monitor SNF activity for potential applications, new applications, pending applications (with A/R balances), approved applications, appealed applications, and re-determination of continuous eligibility application. Work with SNF to mitigate company financial risk associated with uncooperative customers, process breakdown, and administrator escalations. Documents all activities in appropriate tool to manage progress and communicate status, e.g. Customer Master Profile. Deliver training offerings on Medicaid Application Process in one-on-one or group sessions. Demonstrate care and compassion to ensure that all internal and external customers consistently receive the highest quality of service. Show respect and appreciation to others. Work with a positive attitude, demonstrating teamwork and enjoyment for the job. Demonstrate focus and discipline to in doing the best job possible. Perform other duties as requested. Should preferably have college degree with 5-7 years of experience in Long Term Care /Healthcare industry or equivalent experience in County Agency. Accounting, Insurance, Paralegal experience may be transferable.
Requisition Number: 247815