Medicaid Specialist in Baltimore, Maryland at West Baltimore PACE Community Coalition LLC

JOB SUMMARY

Under the direction of the Director of Enrollment Growth, this position is responsible for establishing and maintaining Medicaid eligibility for PACE participants. This includes: preparation and submission of potential participants' Medicaid applications, tracking and processing redeterminations (RRR) for participants, and serving as the organization's liaison to Maryland Health Department and case managers to expedite the application and enrollment process.  

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Initiates Medicaid application process for potential participants, including application completion,assistingapplicants with gathering and processing verification items, application submission, and coordination with county case managers,trackingand follow-up of application status
• Provides initial telephone point of contact with potential participants and participants’ family/care giver and referral sources as needed
• Completing home visits as necessary to aid in this process
• Conducts consistent professional written and verbal communication with referral sources, and documents these communications in the Electronic Health Record
• Requests and tracks requests for records and other required paperwork from doctors’ offices, and other sources as needed
• MaintainsMedicaid Tracking database including tracking time to approval from submission to DHCF to approval by DHCF
• Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format
• Prepares forms from DHCF and tracks the participant’s recertification (RRR) with DHCF to make sure they are approved year to year
• SupportsPACE ofWestBaltimorefinance department in validation of Medicaid payments and revenue cycle as needed and requested by the Finance Dept.
• Completes and recordsinitialand annual verifications of participants’ incomes.
• Maintains and updates participant shared payments for Assisted Living Facilities (ALF)

• Coordinates intake of new participants as necessary
• Maintains professional affiliations and any required certifications.
• Additionalresponsibilities will be added atmanagersdiscretion, as career growth opportunities and responsibilities are constantly arising in our flexible and start-up environment.

QUALIFICATIONS

Experience:

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experiencerequired
• Thorough understanding ofMaryland DHS, Medicaid, and Social Security processes
• Extensive knowledge of community resources available to seniors and their families
• Ability to effectivelyrepresentthe program to participants, families, outside agencies, community groups, communityprofessionalsand thegeneral public
• 1 year experience working with the frail and/or elderly populationsrequired
• Experience working with an Electronic Health Record preferred
• Mustsubmitto and pass a pre-employment drug/alcohol screening and criminal background check
• Must have a current driver’s license and driving record must be in compliance with company policy.
• Operates in full compliance with all applicable federal,stateand local fire, health, safety, sanitation, Emergencyproceduresand other Standards prescribed in law or regulations

ABOUT PACE of West Baltimore

PACE of West Baltimore (Program of All-Inclusive Care for the Elderly) is an integrated, home and community-based care model designed to help seniors maintain their independence and remain part of their communities for as long as safely possible. We care for our participants through a harmony of center-based services and personalized in-home care, spanning clinical, behavioral, and social services.

PACE is a proven, cost-effective care model, saving states an average of 13% versus other Medicaid services, including nursing homes and community-based waiver programs. PACE of West Baltimore’s unique approach to PACE is enhanced by our deep expertise in in-home care, clinical geriatrics, data analytics, and virtual care technology, all for the purpose of improving the health and quality of life of our patients.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

PACE of West Baltimore is an Alcohol/Drug/Smoke-Free Workplace

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical Requirements:While performing the duties of this job, the employee isfrequentlyrequired to stand; walk; lift heavy objects; sit; use hands to finger, handle or feel objects, tools, or controls; talk, see,hearand smell.  Requires full range of body motion, manual and finger dexterity, and eye-hand coordination; requires the ability to use department equipment, to communicate effectively; The employee is occasionally required to reach and stretch with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee maybe requiredto endure extremes in temperature and may work in hazardous environments where personal protective equipment isrequired. Requires the ability to lift/carry up to 50 pounds and push or pull objects exceeding 150 pounds, usingappropriate bodymechanics. 
• Visual, Hearing and Communication Requirements: Requires corrected vision andhearing towithinnormalrange, with or without reasonable accommodation. Must be able to communicate effectively in verbal and written form with all levels of personnel within and outside of the organization.   
• Pressure Factor: Requires working under stressful conditions. Moderate pressure to meet scheduled and recurring deadlines.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Environmental Conditions: Working conditions may be noisy with fluctuating indoor temperatures.  Must have the ability to work under moderate pressurein order tomeet scheduled appointments or deadlines while dealing with frail, disabled and/or confused participants/clients. Subject to individuals who may have the potential for physical or verbal aggression. May be exposed to a risk of bodily injury through contact with moving instrumentation, toxic substances, medicinal preparations, bodily fluids, communicablediseasesand other conditions common in a clinic environment. Subject to unpleasant odors.