Regional Medicaid Specialist

CommuniCare•Akron, IN

3d•Hybrid

About The Position

Communicare Health Services is currently recruiting a dynamic individual with prior Business Office or Admissions experience in Long Term Care for the position of Regional 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. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional, person‑centered care as a national leader in post‑acute services for individuals with chronic or complex conditions. Today, our more than 105 skilled nursing and long‑term care facilities serve nearly 13,000 residents at any given time. To support our centers and ensure long‑term success and continuity of care, CommuniCare has developed integrated lines of business spanning the full continuum of care. These specialized solutions include chronic disease management, memory care, telehealth services, Medicare insurance plans, behavioral health programs, and comprehensive medical services. Together, they enable us to deliver sophisticated, coordinated, and transformative care beyond the walls of our facilities. Our mission, Serve with Pride , is evident in the quality and consistency residents, families, and community partners have come to expect and trust. With more than 14,000 employees serving communities across Ohio, Indiana, Virginia, and West Virginia, we are dedicated to improving the lives of our residents by placing extraordinary service above all else. We continue to raise the bar and innovate wherever possible to enhance quality of life—creating environments where residents feel at home, employees thrive, and families find comfort and confidence in the care we provide.

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.
Prior management training.
Basic computer literacy and skills.
Prior experience preferably with related software applications.

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.