Medicaid Specialist

The Health Center at Standifer Place


Date: 4 days ago
City: Chattanooga, TN
Contract type: Full time
2626 Walker Rd.

Chattanooga, TN 37421

423-490-1599

Line Of Authority

  • Business Office Department Head
  • Administrator

Qualifications

  • Degree
    • Prefer Master’s degree in Social Work from school or university accredited by the council on Social Work education or
    • Bachelor’s degree from accredited college or university
  • Experience in dealing with people in crises is preferable.
  • Knowledge of the case management process, needs of geriatric patients, health care settings, working knowledge of funding resources such as Medicare Part A, B, C and D, Medicaid, Managed Care and other private insurances.
  • Imagination and creative ability, skill in working cooperatively with other professionals, ability to organize and carry out responsibility efficiently and effectively.
  • Ability to communicate effectively and appropriately both verbally and in writing in a wide variety of circumstances.
  • Commitment to the mission and goals of the center.
  • Ability to exercise independent judgment where procedures cannot be standardized.
  • Dedicated totally to the success of the center and The Better Way culture.
Physical Demands

  • Able to lift 20-40 lbs. on occasional basis.
  • Able to bend, stoop, squat and twist numerous times daily.
  • Able to see and hear adequately in order to respond to auditory and visual requests from patients.
  • Able to speak in a clear concise voice in order to communicate with patients who may be hearing impaired.
  • Able to carry out fine motor skills and manual dexterity.
  • Able to manage own stress effectively.

Working Conditions

  • Well lighted, well ventilated office space.
  • Interacts with general public under all conditions. Much of the work involves difficult circumstances, patient and families in emotional distress, severe illness, dying, death and grief, confusion, combativeness, ill-temper, etc..
  • Constant pressure to respond maturely and effectively with patients, families, other staff and other professionals.
  • Must appropriately represent center in dress and demeanor per the partner handbook and any written regional policy.

Duties

(Note: Specific duties are assigned at the discretion of the Business Office Department Head and may be adjusted to meet the needs/expertise of personnel available.)

General Description

  • Gather current information available about funding resources.
  • Work with individual patients and families toward understanding there funding resources
  • Inform individual patients and families of the need for applying and becoming eligible for Medicaid benefits.
  • Assist individual patients and families with their application for Medicaid benefits including but not limited to gathering supporting documentation.
  • Assist individual patients and families with their renewal applications for Medicaid benefits including but not limited to gathering supporting documentation.
  • Serve in an advocacy role for patients and their families in expressing, defining and resolving grievances.
  • Participate in in-service training programs.
  • Evaluate the quality of the Business Office and of Social Services as part of the center’s overall quality improvement program.
  • Develop and maintain contacts with appropriate community agencies.
  • Handle some marketing activities/functions assigned by the Business Office Department Head.

Duty Areas

  • Funding information:
  • Provide family and patient with accurate, up to date information regarding funding resources such as Medicare Part A, B, C and D, Medicaid, and Private insurances.
  • Inquiry Management:
    • Maintain professional working relationship with government agencies including the Tennessee Department of Health, Hamilton County DHS office and Social Security Administration to share and obtain information concerning a patient’s application for Medicaid benefits and any renewals.
  • Financial/Medical Records:
  • Keep current a report summarizing the financial and discharge status of all patient’s who may possibly need Medicaid benefits.
    • Create and maintain files on all patients who may need or who have Medicaid benefits,
    • Document, clearly and legibly.
    • Document reports of progress at required intervals.
  • Ombudsman:
    • Maintain relationship with patient and family in order to facilitate early identification of potential problems.
    • Maintain close working relationship with all other departments in appropriately resolving grievances.
    • Identify and report trends or patterns of complaints to the Business Office Department Head.
    • Manage difficult or emotional customer situations.
  • Case Management with patients and families:
    • Respond to immediate need of any patient or family referred by floor staff, DON, therapists, administrator, or physician.
    • Encourage maximum participation of family in meeting needs of patients.
    • Respond promptly to customer needs.
    • Proactively work to meet and/or exceed customer expectations.
    • Build a relationship of trust and respect with customers.
    • Develop knowledge of criteria utilized by Medicaid and other third party payors for continued stay authorization in order to educate patient and families.
  • Transition/Discharge Planning:
    • Obtain information from family and patient on admission regarding expectations and resources available for discharge planning.
    • Collaborate with other care plan team members to confirm and stay current on a patient’s discharge plans.
    • Coordinate in-house planning and assist patient and family in obtaining services needed to assure continuity of care.
    • Participate in Utilization Review to advise committee on discharge planning.
  • In-Service Education:
    • Participate in continuing education programs available, with consent of Business Office Department Head.
    • Participate in in-service education of staff in areas of expertise, especially emotional needs of elderly, patient’s rights, confidentiality and the Abuse Policy.
  • Quality Improvement:
    • Participate in quality improvement program of center.
    • Understand the QI process.
    • Participate in survey processes conducted by state regulatory agencies.
  • Other duties which may be assigned by Business Office Department Head.
Responsibilities

  • The Medicaid Specialist is responsible for the quality of Business Office and Social Services rendered by the center.
  • Report to the Business Office Department Head the current status of the business office and present needs as perceived by the Medicaid Specialist.
  • Understand and abide by established policies of health care center and interpret them to concerned parties.
  • Participate in consultation with the Business Office Department Head, especially pointing out problems and trends that may require company policy attention.
  • Maintain confidentiality of professional information.
  • Abide by the Policies and Procedures in the Business Office Manual and the Social Services Manual.
  • Account for use of time, report sickness, and plan vacation time with the Business Office Department Head.
  • Assuring Resident Safety

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