Medicaid Specialist

St Camillus Residential Health•Syracuse, NY

49d•$22 - $26•Onsite

About The Position

St. Camillus is hiring a full-time, on-site Medicaid Specialist for its Patient Financial Services team. The role works with Patient Financial Services and Finance staff, residents, and family members to review insurance coverage, assess financial liability and Medicaid needs, estimate residents’ Net Available Monthly Income (NAMI), and complete and monitor Medicaid applications and recertifications. The specialist also maintains knowledge of third-party billing regulations and supports day-to-day billing functions as needed.

Requirements

Associate’s degree.
Experience in Medicaid eligibility and/or skilled nursing facility Medicaid billing.
Strong Microsoft Office experience, including Word and Excel.
Strong verbal, written, computer, and leadership skills.
Ability to work as a team player and build strong relationships with residents and their families.
Ability to work independently while managing multiple projects at once.
Knowledge of current Medicaid regulations and the Medicaid application process.
Knowledge of general skilled nursing facility payers and billing procedures.

Responsibilities

Review residents’ insurance coverage with families throughout their stay, explain potential financial liability, and determine whether and when Medicaid may be needed.
Estimate residents’ Net Available Monthly Income (NAMI) and ensure that NAMI income is received by the facility.
Complete residents’ Medicaid applications and annual recertifications within required timeframes.
Track Medicaid application deadlines and status, and communicate with the local DSS office, St. Camillus staff, residents, and families to support timely approval and cash flow.
Obtain required documentation from families or, when needed, work with financial institutions to obtain it on their behalf.
Complete and submit requested Medicaid forms and documents, including LDSS 3559s, Nursing Home Account Sheets, and PRIs.
Maintain accurate records of members’ eligibility status, recertification dates, and MLTC providers.
Use financial reports to identify private accounts that may need Medicaid.
Enter approved Medicaid application information into the billing system for processing.
Report Medicaid application issues routinely to the PFS Manager, Director of Finance, and VP of Finance.
Provide written referrals and supporting documentation for Medicaid cases requiring attorney involvement.
Assist with billing tasks as needed.
Assist with financial audits initiated by outside agencies, including the Office of the Medicaid Inspector General (OMIG) and Social Security.
Support the department Manager, Director of Finance, and VP of Finance with required tasks.
Help prevent employee injuries, follow safety rules, and address safety issues with a supervisor.
Perform other duties as assigned by a supervisor.