Medicaid Program Integrity Jobs in Tucker, GA (NOW HIRING)

POSITION SUMMARY                     

Under limited supervision, performs a variety of administrative and clerical duties that require a broad range of software and critical thinking skills, plus comprehension of organizational policies and procedures, while maintaining confidentiality and professionalism. Primary functions include managing all aspects of Medicaid Eligibility including the submission and tracking of Medicaid applications, training staff on Medicaid, and developing and maintaining a professional relationship with each DFCS district.  

MINIMUM JOB REQUIREMENTS   

Education & Qualifications:

Education: High School Diploma or equivalent required.  College degree preferred.

Previous Experience: Two years’ experience in healthcare; preferred. 

Knowledge & Training: Must be able to type a minimum of 40wpm with little to no error and function independently in multi-disciplinary setting. Requires proven interpersonal skills with ability to communicate effectively. Demonstrates proven decision-making skills, organizational and time management skills.  Working knowledge of word processing, spreadsheets, and general computer skills. 

Computer Skills: Must be familiar with general use and functions of the computer with regard to: User names and password concepts; effective use of the internet as a research tool; communication and calendaring skills via Outlook e-mail program; navigation of desktop computer or laptop to include: starting programs from startup menu or desktop icons; opening, Creating and Saving a new document; use of Save As function in use of template & form documents; use of file management technique on both public and personal drives. Intermediate use of MS windows applications, i.e.: Word, Excel, Outlook; effective use of navigation buttons and tool bars; ability to self-manage online HR services and online training programs.

Transportation: Must have reliable transportation.

JOB SPECIFIC EXPECTATIONS

Clerical/Administrative: 

• Submit Medicaid applications timely and in accordance with CCSP standards of promptness.
• Conduct all Medicaid related activities and follow-up including obtaining service start dates and application tracking.
• Monitor and manage COMPASS/GATEWAY Medicaid application systems.
• Navigate/Operate GAMMIS to verify Medicaid status and eligibility type.

• Check portal for statuses as needed for staff and for incoming referrals. 
• Send letters to clients/families of needed verifications. 
• Conduct phone interviews with clients, families, and DFCS, as needs arise. 

• File documents in client’s electronic chart in Harmony/Framework in the standards of promptness and with accuracy.
• Date stamps all Medicaid and DFCS related incoming mail as needed.

Customer Service:

• Develop and maintain professional relationships with each DFCS district and act as CCSP liaison with DFCS.
• Provide clients and other external partners’ timely and thorough communication regarding Medicaid status.
• Receive and relay messages related to Medicaid applications/statuses to appropriate persons in a timely fashion.

• Professionally represent CCSP and VNHS at Medicaid conferences/all external meetings.

Communication:

• Document necessary communication in Harmony/Framework including entering notes in the electronic system to show progress of application and communication with DFCS and VNHS staff about application status.
• Compose and convey thorough communication to internal and external audiences as it relates to Medicaid. 
• Navigate client databases and program specific spreadsheets/documents, assisting with database maintenance in Framework.
• Coordinate ongoing updates on Medicaid statuses with VNHS staff

Organization:

• Provide Medicaid training to new CCSP staff and on-going Medicaid training to all CCSP staff.

• Enter notes in Harmony/Framework to show progress of application and timely communication with DFCS and VNHS staff about application status. 

• Maintain a task-specific reference guide as it relates to daily/weekly duties to ensure continuation of flow during planned/unplanned absences.

COMPANY EXPECTATIONS

Values:    Upholds and lives the Values of Visiting Nurse Health System:

• Respect and Integrity
• Excellence
• Stewardship 
• Care