Medicaid Processor Jobs (NOW HIRING)

The Medicaid Liaison is responsible for acting as the bridge between our skilled nursing and assisted living facilities and Medicaid agencies. The role involves guiding residents and their families through the Medicaid eligibility process and ensuring compliance with all relevant Medicaid guidelines. This position offers a hybrid work arrangement, combining both remote and on-site responsibilities.

Essential Duties and Responsibilities

1. Reimbursement Leadership
   1. Serve as a liaison between skilled nursing and assisted living facilities and Medicaid agencies to ensure proper communication regarding Medicaid eligibility processes.
   2. Conduct thorough assessments and interviews to determine Medicaid eligibility for potential residents and provide them with an understanding of their Medicaid options.
   3. Guide residents and their families in completing Medicaid applications and supporting documentation.
   4. Advocate for residents during Medicaid eligibility reviews and appeal processes, ensuring that residents receive the benefits they are entitled to.
   5. Collaborate with interdisciplinary teams including clinical, admissions, and financial staff to ensure that Medicaid applications are submitted on time and accurately.
2. Strategic Planning
   1. Monitor Medicaid eligibility trends and regulatory updates to proactively adjust strategies for maintaining compliance.
   2. Assist in developing and implementing strategies to optimize Medicaid reimbursement by ensuring all required documentation is submitted for eligible residents.
   3. Work closely with clinical and administrative teams to identify Medicaid-eligible residents in a timely manner and assist in the development of comprehensive care plans.
   4. Promote effective utilization of Medicaid to maximize funding opportunities for residents in need of long-term care services.
   5. Ensure that the processes for Medicaid application and eligibility determination align with organizational goals.
3. Compliance and Regulatory Oversight
   1. Maintain an in-depth understanding of Medicaid regulations, eligibility criteria, and potential changes in policies that impact service delivery.
   2. Ensure that all Medicaid applications and documentation meet federal and state requirements.
   3. Collaborate with legal and compliance teams to ensure that the organization adheres to all regulatory guidelines related to Medicaid.
   4. Keep residents and families informed of any changes in Medicaid rules and advocate for residents during eligibility appeals and audits.
   5. Regularly conduct internal audits of Medicaid documentation to ensure compliance and identify potential issues before they become problems.
4. Documentation and Record Keeping
   1. Maintain accurate, up-to-date records of all Medicaid applications and their status throughout the process.
   2. Track all communications with Medicaid agencies and residents, ensuring that any changes or updates to a resident's eligibility are promptly recorded.
   3. Ensure that all documentation is in line with organizational standards and supports accurate reimbursement processing.
   4. Work closely with the finance and billing departments to ensure that Medicaid claims are processed efficiently and that documentation supports payment audits.
5. Staff Development and Leadership
   1. Provide ongoing training and mentorship to staff members who interact with Medicaid applications, ensuring they understand eligibility rules and documentation requirements.
   2. Encourage a collaborative environment within the team to ensure effective communication about Medicaid eligibility determinations.
   3. Conduct regular meetings with team members to review processes, share best practices, and ensure that all tasks are completed in a timely manner.
   4. Promote continuous learning within the team by staying updated on changes to Medicaid regulations and ensuring staff members are prepared to adapt.
6. Resident Rights
   1. Honor the resident’s refusal of treatment request.  Report such action to your supervisor.
   2. Abide by the resident’s participation in treatment decision.
   3. Inform the resident of consequences of not participating in prescribed therapy and document such action in the resident’s clinical record.
   4. Report any complaints or grievances to the department supervisor.
   5. Report and investigate all allegations of resident abuse and/or misappropriation of resident property.
   6. Allow the resident to participate in the planning and scheduling of his or her treatment.
   7. Must adhere to all HIPAA requirements.

• Must possess, as a minimum, a high school diploma, an advanced degree is preferred.
• In-depth knowledge of Medicaid eligibility rules, regulations, and guidelines.
• Previous experience in Medicaid application processing and eligibility determination.
• Strong understanding of skilled nursing facilities and long-term care services.
• Excellent communication and interpersonal skills.
• Attention to detail and ability to manage multiple priorities.

#LIONSTONE123

• Health benefits including Medical, Dental & Vision
• 401k with company match
• Early Pay via Tapcheck!
• Employee Perks & Discount program
• PTO + Company Holidays + Floating Holidays
• Referral Bonus Program
• Mentorship Programs
• Internal/Upskilling Growth Opportunities
• Continued Education Loan Repayment Program powered by Clasp