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Medicaid Disability Field Specialist, Financial Counseling

Winston Salem, NC, United States
Job ID: 104273
Job Family: Clerical Support
Status: Full Time
Shift: Day
Remote Opportunity: No
Job Type: Regular
Department Name: 55811088941321-Financial Counseling

Overview

Medicaid Disability Field Specialist, Financial Counseling

40 hours per week, day shift

JOB SUMMARY:    
Executes strategic and aggressive measures to facilitate, expedite and enhance the Medicaid and Social Security Disability/Supplemental Income (SSD/SSI) application and approval processes.  Incumbents in this position are required to engage in critical and complex decision-making based on the interpretation of federal rules, laws and regulations with the purpose of securing positive reimbursement outcomes for the health system as it pertains to Medicaid approvals. 

EDUCATION/EXPERIENCE:
Four to six years as a Social Services Income Maintenance Caseworker or six years experience in a hospital or clinic based Medicaid referral department/unit.  A Bachelors degree in Business or Human Services is preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION:
Valid North Carolina Driver's License

ESSENTIAL FUNCTIONS:  
1.    Develops and maintains knowledge of Federal Regulations and all rules and laws that govern Medicaid and Social Security disability/Supplemental Security Income for all states.
2.    Follows all HIPAA and Privacy laws while pursuing application approvals by assuring that all required releases and permissions have been signed by the patient or legal representative prior to submitting any financial or clinical documents to any requesting entity. 
3.    Provides transportation to patients/families when this is needed or requested in order to facilitate the Medicaid and SSD/SSI application processes. Assures that all appropriate documents have been signed by the patient or legal representative prior to acting on the patient's behalf. 
4.    Acts on the patient's behalf as it pertains to the hearings and appeals processes when applicable.  Prepares pre-hearing packages with the intent of reversing adverse disability decisions by the Department of Disability Determination Services (DDS) and/or Social Security Administration.  
5.    Reviews and scrutinizes patient medical records to assist with disability determinations and the appropriateness of and merit of appealing disability denials.
6.    Provides thorough follow-up with and facilitates the efforts of the County Department of Social Services (DSS) offices in an effort to expedite approval of Medicaid applications.  
7.    Conducts property searches of public records as needed to validate or disclaim excess reserve issues at any Tax or Register of Deeds offices when indicated.
8.    Applies knowledge of Adjudication Procedures as they relate to the appeals processes at the local, state and Administrative Law judge appeals levels.
9.    Facilitates the needs of those patients requiring discharge to a lower level of care by assisting with the Medicaid application process through field work when indicated.
10.    Performs close examination of disability denials and determines when to assist the patient/family with pursuing the appeals process.  
11.    Accurately tracks and reports Medicaid approval and denial outcomes on a monthly basis.  Assures that all systems are thoroughly and documented with detail and assures that all patient files/information are kept secure and confidential. 

12.    Consults with the health law attorney for clarification and interpretation of federal law in difficult and/or unusual eligibility cases when indicated and with approval.

13.    Meets productivity requirements to ensure excellent service is provided to customers.

14.    Meets / exceeds performance expectations of 98% accuracy rate and established department productivity measurements. 

SKILLS & QUALIFICATIONS:

  • Must be able to exercise discretion, vital decision-making and independent judgment under stressful conditions and sometimes time restricted situations
  • Must possess strong interpersonal, interactive, interpretive, communication and interviewing skills including verbal, non-verbal, written and listening
  • Position requires strong mathematical and multi-tasking skill-set
  • Developed computer skills including execution of word processing and spreadsheet applications
  • Must be detail-oriented and possess above average analytical and problem-solving skills
  • Strong working knowledge and understanding of benefits and reimbursement methodologies as they relate to Medicare, Medicaid and Managed Care benefits and contracts   
  • Must be able to work independently in conjunction with strong organizational and time management skills
  • Must utilize strong background and work experience with financial statements for the purpose of determining eligibility for Adult or Family Medicaid programs, state assistance and/or Charity Care
  • Must possess advanced knowledge and understanding of Federal and State Medicaid rules, laws and regulations
  • Enhanced knowledge due to prior experience in eligibility requirements governing Social Security Disability (SSD) and Supplemental Security Income (SSI) 
  • Must be able to execute applied and enhanced knowledge and understanding of medical diagnoses/prognoses as they pertain to disability approval in conjunction with SSD regulations
  • Must be able to serve as a Medicaid eligibility educational resource for patients/families, physicians, Social Workers, Case Managers and others as the need occurs
  • Must be able to read, interpret and execute written guidelines, rules and laws in the Federal Regulations and Medicaid Manual for various states and the SSD/SSI programs as outlined by the DMA and the SSA 
  • Background knowledge and understanding in medical terminology and medical coding 
  • Understanding of appropriate usage and assignment of CPT and ICD-9 codes
  • Ability to communicate with physicians regarding clinical requirements for Medicaid Approval

WORK ENVIRONMENT:

  • Clean well-lit and comfortable climate
  • Moderate to loud noise environment depending on work location
  • Fast-paced and sometimes hurried surroundings
  • Subject to many interruptions
  • Occasional to frequent stress due to job subject matter 

PHYSICAL REQUIREMENTS:
Amount of time spent performing the following activities:
0%    35%    65%        
to    to    to        
35%    65%    100%    N/A    Activity
X                Standing
X                Walking
        X        Sitting
X                Bending
        X        Reaching with arms
        X        Finger and hand dexterity
        X        Talking
        X        Hearing
        X        Seeing
X                Lifting, carrying, pushing and or pulling:
            X    20 lbs. maximum
            X    50 lbs. maximum
            X    100 lbs. maximum