Medicaid Specialist / Collections Specialist

General Purpose:

The Medicaid Specialist acts as a liaison between patients, skilled nursing facility, and government agencies, ensuring that residents receive the benefits they are entitled to and that applications are processed efficiently and accurately.

Essential Job Functions:

This facility expects their employees to promote an atmosphere of teamwork with other employees, hospitality, and comfort for its residents. Therefore, the following list of duties is not all-inclusive:

• Prepare and submit reports on a timely basis as required and directed by Business Office manager, Administrator, this company and governmental agencies.
• Secures documentation for Medicaid/MSP new applications and renewal applications if needed for members’ attention to detail by adhering to state requirements and securing supporting documentation.
• Collaborates with government offices to accurately complete the application and recertifi- cation process.
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by en- suring proper phone etiquette and adherence to scripts, state regulations, HIPAA compli- ance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation.
• Review financial statements, check personal information, and analyze eligibility requirements.
• Contact Medicaid with problems of recertification and budget determinations.
• Accumulate and maintain, in an organized manner, vital statistics relating to admissions, discharges, deaths, transfers and daily census of facility residents.
• Bill Medicaid claims weekly.
• Responsible for weekly Medicaid billings along with timely follow-up with intermediaries on delinquent payments.
• Monitor and manage the accounts receivable collection process.
• Pursue past due accounts persistently and maintain proper back-up documentation
• Obtain and submit all required documentation to bill third party payers as per program/company guidelines.
• Verify that resident trust is accurately recorded.
• Provide statistics to audit and reimbursement for year-end • processing.
• Maintain an accurate accounting of patient trust funds including monthly reconciliation and quarterly statements to responsible parties. Reconcile petty cash for Patient Trust Fund daily.
• Participate in the resident admission process by providing explanations of the facility’s rates, billing cycle and payment terms, including collecting the first month’s advance payment upon admission.

Other Duties: