Medicaid Eligibility Specialist

Description

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the entire Southeast. Our independent and assisted living facilities, Cypen Towers, are located just north of mid-town Miami in a peaceful and inviting 20+-acre community.

We provide expert care and all-amenities services to hundreds of residents each day. That means meals, housekeeping, activities, healthcare, security and more. Join us now to do purposeful work with our diverse and respectful team.

Job Title: Medicaid Pending Specialist

Job Summary

Determines financial viability of admission by verifying insurance coverage and obtaining appropriate insurance authorization, and reauthorization as needed.

Essential Job Functions

• Reports to Business Office Manager to promptly determine financial viability
• Contacts insurance/payor source to verify coverage levels, responds promptly and accurately to telephone, written, and electronic inquiries from admission, providers, and in-house departments
• Responsible for identifying significant gaps in coverage when applying for Medicaid creating the patient to pay privately.
• Document authorizations, denials, or status updates in PCC.
• Maintains a deep understanding of Medicare, Medicaid, and all major insurance plans
• Actively participates in necessary meetings such as Private Pay, Medicaid Pending, Hospice Pending, etc.
• Completes reports, special projects and other duties as assigned
• Completes Medicaid application in collaboration with family
• Uploads all necessary information in Point Click Care (PCC) & the Medicaid Web Portal
• Obtains authorizations/re-authorizations for Medicaid patients monthly.
• Review to ensure forms such as, 2515/2506 and 3008 are completed, signed, and dated by appropriate departments to obtain and maintain Medicaid coverage.
• Tracks and submits Medicaid recertifications
• Reviews and works SIXT/MEDP lists
• Review and confirm the social work department are completed, signed, and dated forms 701b/701Ts to be submitted to CARES (Elder Affairs).
• Work with and monitor closely 3rd party vendors that may be involved.
• Routinely communicates with community partners such as DCF and CARES on member status
• Documents in PCC

Job Requirements

Education:

• Two-year college or combination of education and experience

Experience:

• 2+ years of related insurance verification experience

Licenses/Certifications:

• N/A

Abilities Required

• Sensitivity and skill required in working with impaired elders and families by phone (if speaking with admission or families)
• Extensive knowledge of different types of payor coverages and policies.
• Exceptional organizational, time management, communication, and telephone skills. Bi-lingual (English/Spanish or Creole) a plus
• Proficient computer skills required
• Sensitivity and skill required in working with impaired elders and families by phone (if speaking with admission or families)
• Extensive knowledge of different types of payor coverages and policies.
• Exceptional organizational, time management, communication, and telephone skills. Bi-lingual (English/Spanish or Creole) a plus
• Proficient computer skills required

Functional Demands

Environment Work Conditions:

• Normal working condition with adequate lighting and ventilation

Infectious Material Exposure:

• N/A

Organizational Expectations

• Ensures that resident's/patient's rights are adhered to
• Demonstrates professionalism and accountability
• Demonstrates a caring attitude consistent with Miami Jewish Empathicare SM toward MJH residents, patients, family members, employees, and other facility guests
• Demonstrates excellent communication skills
• Ensures confidentiality and security of patients' medical information
• Identifies and utilizes appropriate channels of communication
• Able to speak, read and write English
• Able to think and act calmly to meet unusual occurrences of the job
• Adheres to the organization's Mission, Vision and Values
• Participates in departmental activities, meetings and in-services and follows established guidelines
• Maintains a safe working environment

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

We believe in the power of empathy, the value of relationships and the importance of a life well-lived. Come see why Miami Jewish Health is unlike anywhere you've ever worked before. We offer competitive compensation, medical/dental/vision coverage and a 403(b)-retirement savings plan for eligible full and part-time positions, free on-campus parking, an onsite fitness center and more .

Miami Jewish Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.