Medicaid Specialist Enrollment Coordinator- PACE

TriHealth•Norwood, OH

About The Position

TriHealth is actively recruiting for a Medicaid Specialist Enrollment Coordinator to join the PACE of Cincinnati PACE Center located in Norwood Ohio. Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. Job Overview: To assist PACE of Cincinnati participants through the Medicaid enrollment and recertification process for PACE. Work and communicate closely with Hamilton County Job and Family Services to ensure a timely and coordinated PACE Medicaid enrollment. Work closely with the enrollment team, and community partners to ensure good communication and smooth transitions of care.

Requirements

High School Diploma or GED (Required)
1 - 2 years of experience in social services or direct customer service or an equivalent combination of education and experience. (Required)
Basic Life Support (BLS) Certified.

Responsibilities

Submit required forms to appropriate County Department of Job and Family Services.
Maintain log of cases: Enrollments, recertifications, proposed for termination, completed cases, denials, etc.
Process participants for presumptive enrollment if eligible and permitted by Ohio.
Contact individual/individual representative(s) upon receipt of case to introduce self and determine assistance needed with Medicaid application process.
Act as authorized representative when determined appropriate for initial applications.
Monitor case for authorization and notify all parties of case disposition.
Access MITS to verify PACE enrollment status and notify appropriate staff.
Monitor MITS on a regular basis to ensure individual remains active in PACE.
Monitor case throughout Medicaid application and approval process and assist individual with collecting and submitting verifications to the local Hamilton County JFS.
Ensure proper enrollment paperwork is completed and submitted.
Make visits to the homes of participants to obtain necessary information and copies of documents required to complete the Medicaid process when needed.
Assist enrolled participants with the Medicaid recertification process.
Create and maintain files.
Verify that all documents are present in electronic file when file is complete.
Document all activities as per PACE of Cincinnati policy and procedure.
Access confidential information on a daily basis, share confidential information with appropriate entities in accordance with HIPAA regulations and PACE of Cincinnati policies.
Anticipate and schedule appointments.
Submit any additional information requested at appointment in a timely manner.
Document communication with individual/individual representative/facility, Interdisciplinary Care Team members and regarding case status until individual is enrolled.
Develop and maintain professional working relations with other PACE of Cincinnati team members, Hamilton County JFS staff and other participants or organizations involved in the individual’s care or Medicaid process.
Responsible for maintaining effective relationships with PACE of Cincinnati leadership and staff, contract network providers, and federal and state agencies.
Responsible for professionally representing PACE of Cincinnati in the community at large.
Other duties that might be assigned to support PACE operations.