Key Responsibilities
1. Medicaid Application & Eligibility
- Completes Medicaid applications with assistance of residents and families
- Gather required financial and legal documentation (bank records, assets, income)
- Submit applications and track approval status
- Monitor eligibility timelines and renewal deadlines
- Complete Recertification and Conversion application
- Complete Medicare applications for new residents 65 and older
- Disenroll from Managed Medicaid when applicable
1a. Residents Income /Residents Funds
· Complete address change for all income on all residents
· Maintain RFMS accounts for all residents
· Issue checks from RFMS account when necessary
· Update RFMS accounts with any credit and debits weekly
· Prepare resident statements for distribution quarterly
2. Financial Case Management
- Review residents’ financial status to ensure compliance with Medicaid rules (financial screening for potential new patients)
- Help structure spend-down strategies (within legal guidelines)
- Track patient liability (how much the resident must contribute toward care)
3. Communication & Liaison Work
- Act as the main point of contact between:
- Residents/families
- State Medicaid offices
· Social workers and admissions staff
- Respond to Medicaid inquiries, requests for additional documentation, or audits
- And any other tasks within your scope of practice that is requested of you by administration
4. Compliance & Documentation
- Maintain accurate and organized resident financial records
- Ensure compliance with federal and state Medicaid regulations
- Prepare for audits and ensure files are audit-ready
5. Billing & Reimbursement Support
- Coordinate with billing department to ensure proper Medicaid reimbursement
- Resolve eligibility or coverage issues that affect payment
Required Skills & Qualifications
- Knowledge of Medicaid rules and long-term care eligibility requirements
- Strong attention to detail and organization
- Ability to interpret financial documents
- Excellent communication and interpersonal skills
- Experience with healthcare administration, social services, or finance preferred
Typical Education & Experience
- Associate’s or Bachelor’s degree (Healthcare Administration, Social Work, Finance, or related field)
- Prior experience in:
- Nursing home administration
- Medicaid processing
- Case management or admissions
Work Environment
- Typically based in a nursing home or long-term care facility
- Works closely with admissions, billing, and social services teams
- May handle a high caseload of residents with strict deadlines