Participant Benefits Specialist

AcuteCare Health System LLC•Owensboro, KY

16d

About The Position

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: We listen to our participants and their caregivers to truly understand their needs and desires. Participant Benefits Specialist JOB SUMMARY Under the supervision of the Business Operations Manager is responsible for assisting participants and families in the application process for Medicaid. Maintains log of Medicaid eligibility. Meets with family and/or potential participant to complete Medicaid application, to ensure eligibility for enrollment. Assists Medicaid Representatives in difficult situations that may arise, which may include meeting with participants, families, social workers and county workers. Assists with any open position caseloads. Training of new employees on home visits, Medicaid rules and regulations, examples of potential difficult situations, and Supportive Housing Forms.

Requirements

Knowledge of Medicaid system and benefits
High school diploma required
Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.
Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.

Responsibilities

Works closely with Marketing and Enrollment Specialists and the Accounting Department to ensure Medicaid payment for eligible participants.
Provides support and back-up to the Enrollment Specialist with regards to Medicaid operations. Works with Medicaid staff to resolve difficult cases.
Works with the Enrollment/Marketing Staff on getting Medicaid approval for new enrollees. Effectively communicates with the Enrollment/Marketing staff on the status of cases and problem solves challenges on gathering information.
Provide excellent customer service skills and works with families and participants in a timely manner to assist them in completing the paperwork needed for Medicaid eligibility.
Develops and maintains working relationships with county technicians and provides any additional information needed when requested to ensure timely approval of cases.
Will maintain a good working knowledge of current Medicaid rules and regulations and be able to communicate these regulations confidently to family members and participants. (Straight Medicaid, LTC Medicaid, Spousal Impoverishment and Trusts.)
Will have efficient and organized case load and working area.
Responsible for completing disenrollment forms for HMO’s to be disenrolled and given to supervisor.
Performs as a representative by participating in community committees’ when appropriate.
Follows all Policies and Procedures and OSHA safety guidelines.
Maintains the confidentiality of all company procedures, results, and information about participants, clients or families.
Handles potentially infectious specimens with appropriate biohazard precautions, and practices Universal Precautions.
Maintains courteous, helpful and professional behavior on the job. Displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issues. Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards. Will support the success of the entire healthcare team.
Maintains safe working environment. Follows Safety Policies and Procedures.
Participates in continuing education classes and any required staff and training meetings. Maintains professional affiliations and any required certifications.
Performs other duties as required or requested in a positive and helpful manner to ensure a smooth-running work area.