Medicaid Application Specialist

Medicaid Application Specialist for Skilled Nursing Facility

Full Time or Part Time | Days | 8am - 5pm

Are you a detail-oriented professional with expertise in New York Medicaid specific to Chronic Care benefits in a Skilled Nursing facility setting? Do you thrive in a structured, in-office environment where your skills will directly impact the lives of our residents and their families? This role helps ensure timely and accurate processing of Medicaid applications, maintains organized documentation regarding application status, and facilitates communication between our facility, residents, families, and Medicaid agencies.

The Wesley Community is no longer requiring employees to be vaccinated for COVID-19!

Everything we do at The Wesley Community is guided by our Core Values which form the acronym "CARES" . These Core Values are COMPASSION, ACCOUNTABILITY, RESPECT, EXCELLENCE and SPIRIT. It's more than a job: it's caring that starts in the heart.

Primary Job Duties:

• Prepare, review, and organize Medicaid application packets to aid and assist families through the Medicaid application process to ensure completeness before submission.
• Submit Medicaid applications to county Departments of Social Services (DSS) timely.
• Maintain accurate electronic files of all Medicaid Pending cases, ensuring compliance with company policy and HIPAA regulations.
• Document and maintain a tracking log of all outstanding Medicaid applications with their weekly status.
• Communicate effectively with families, Attorneys, Optum, Summit and County DSS caseworkers, etc. on a daily/weekly basis identifying any areas of concern that require timely responses.
• Prepare and submit resident's Medicaid recertifications annually and timely. Maintain a tracking log of all Medicaid recertifications and status.
• Complete and submit all residents LDSS-3559's (Medicaid change in status) to the county DSS for admissions, leaves, discharges, and changes in placement status.
• Obtain and maintain all MLTC (Managed Long Term Care) plan authorizations and extensions.
• Assist Billing Specialists with billing related duties for all insurance/private pay payers and accounts receivable follow-up.
• Ensure compliance with Medicaid regulations related to billing requirements, regulatory standards, and facility specific protocols.

Qualifications :

• Proven experience with NY Medicaid application financial criteria. Preferably with Chronic Care Medicaid in a skilled nursing/long-term care setting.
• Knowledge of insurance payer types including Medicare, HMO and Private insurance as related to billing and Medicaid coverage needs is preferred.
• Experience with Healthcare billing software Point Click Care (PCC) preferred.
• Must have proficient computer skills including Word, Excel, and Outlook.
• Highly organized individual with the ability to multi-task between projects and deadlines.
• A cheerful outlook with strong written and oral communication skills.

The Wesley Community strives to have its employees be a part of a culture of excellence and to enjoy their work. Our team is also committed to making sure our employees are rewarded for superior effort and performance and get a chance to have fun as part of their employment experience at The Wesley Community.

We offer competitive and team-focused Employee Benefits to include :

• Competitive pay + incentive compensation
• A full benefits package
• Paid vacation, sick, and personal time
• Paid Holidays
• Flexible scheduling options
• NEW Weekly Pay Periods and Daily Pay Option
• A 401K retirement plan
• Tuition assistance and nursing scholarships
• Opportunities for growth and development
• A caring and supportive team work environment
• Perks such as self-care support and on-site prescription fills
• A fun work environment including theme weeks, recognition events, and opportunities for staff involvement

About the Wesley Community:

For over 50 years, The Wesley Community has provided services and programs with a commitment to compassion, caring and excellence. Our distinctive continuum of care offers a unique balance of community living and care giving that ensures quality of life at every stage of life.

We are a mission driven, not-for-profit organization that puts people first. We are proud of our reputation for excellence, innovation, and a personal approach to care and services. We encourage and support our residents in their efforts to achieve their goals, and we treat them respectfully.

If you are ready to embark on a rewarding career that truly makes a difference, we invite you to apply for the Medicaid Application Specialist position at Wesley Health Care Center. We look forward to meeting you!