Medicaid Specialist

CommuniCare Health Services•Charleston, SC

12d

About The Position

Medicaid Specialist Communicare Health Services is currently recruiting a dynamic individual with prior Business Office or Admissions experience in Long Term Care for the position of Medicaid Specialist. Some travel between our facilities in the area is required. This position also requires travel as necessary including but not limited to a resident and/or responsible party home to collect documentation to support applications submitted, financial institutions, Local Department of Job and Family Services. The position of Medicaid Specialist provides assistance with the coordination of financial benefits available to the residents in our Caring Communities. The position must function as both a team member and leader to ensure that work is accomplished and quality service is delivered, supporting team members and leading the way in celebrating team successes. While focusing on delivering quality service, the position must also manage the resources within their control and assist others in managing resources. As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer you a menu of benefit options from life and disability plans to medical, dental and vision coverage, from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients and family members care for and about one another. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.

Requirements

Must be knowledgeable with laws, regulations, and guidelines that pertain to long-term care reimbursement.
3-5 years of Long Term Care Business Office or Social Service experience in healthcare, preferably in a long term care setting
Must possess a thorough understanding of Medicare. Medicaid, Private Insurance, managed care programs
Must have the ability to make independent decisions when circumstances warrant such action.
Must be able to deal tactfully with team members, other staff, residents, family members, visitors, government agencies, and the general public.
Must be willing to seek out new methods and principles and be willing to incorporate them into existing practices.
Basic computer literacy and skills.
Prior experience preferably with related software applications.

Nice To Haves

Prior management training.

Responsibilities

Assist the facility with gathering financial data from the resident, family and responsible party.
Review verifications and determine if qualifications for benefits have been met.
Complete and submit applications to state Medicaid programs
When appropriate become the authorized representative when applying for benefits
Maintain proper documentation to support efforts with all applications submitted.
Escalate difficult cases to management timely
File appeals with the appropriate agency when necessary
Build working relationships with local agency which produces the Level of Care/Pasarr Screen and local agency which determines Medicaid Eligibility
Attend all Medicaid Pending Meetings for assigned facilities.