Medicaid Recertification Specialist

Job Description

Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE").

PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

BENEFITS for Full and Part-time employees who work 30 or more hours per week:

We pay 100% of the MEDICAL monthly premiums for Employee Only coverage.

We pay 100% of the DENTAL monthly premiums for Employee Only coverage.

We provide an affordable VISION monthly premium for Employee + Family coverage.

We pay 100% of BASIC LIFE for a benefit amount of $10,000.

We offer safe harbor matching contributions for the 403(B) RETIREMENT SAVINGS account.

We offer up to fifteen (15) days of PAID TIME OFF based on paid hours per pay period.

We offer eleven (11) company-observed PAID HOLIDAYS.

We offer education and TUITION REIMBURSEMENT.

We offer MILEAGE REIMBURSEMENT.

Bienvivir is currently accepting applications for the following position:

MEDICAID RECERTIFICATION SPECIALIST:

Under the supervision of the Social Work Manager, the Medicaid Recertification Specialist is responsible for providing support to the Social Work Department at all Bienvivir Centers. The Medicaid Recertification Specialist is responsible for assisting the participants/designated decision makers in completing the Medicaid application and providing supporting financial documents to the Health Human Service (HHSE) Medicaid Eligibility Specialist (MES).

RESPONSIBILITIES:

Medicaid Recertification:

1. Type and prepare documents, forms, and/or reports for the Social Work Manager to be submitted to the accounting department on the status of Medicaid Recertifications for participants.

2. Answer calls from participants/designated representatives and respond to general questions related to Medicaid recertification that they may have.

3. Receive, sort, and send Medicaid recertification applications to the participant/designated representatives and/or the Health Human Service Eligibility Specialist.

4. Maintain documentation on F Drive on all Medicaid recertification filed with HHSC.

5. Schedule meetings with HHSC Medicaid Specialists to consolidate recertification renewals and pending items/status on recertification renewals for those participants who are due for renewal monthly.

6. Meet with the Social Work Team weekly to update each participant's recertification status.

7. Collaborate and provide Status to Medicare/ Medicaid Billing Specialists at Bienvivir to prevent interruption in Medicaid coverage.

Records Management:

1. Maintain a report of Medicaid recertification projected dates for yearly renewals to prevent loss of coverage by participants.

2. Process various reports, including:

a. Accounting Report for Medicaid recertification data.

b. Medicaid Recertification Mail-Out reminders to Participants/Designated Representatives and maintain record/log of application status and pending items.

3. Provide TROOP for new enrollments to the Finance Department's Medicaid/Medicare Eligibility Specialist.

4. Assist Social Work Department with assisted living contracts and applied income worksheets as assigned by the Social Work Manager.

Social Work Manager and Department Head Support:

1. Execute, assist with, and ensure the completion of tasks assigned by the Social Work Manager to meet deadlines.

2. Prepare Excel spreadsheets for the Social Work Manager as needed (e.g., Medicaid Recertification reports, maintain recertification updated status on the F drive.)

3. Assists with organizing/coordinating Annual Skills Fair materials and meetings related to Medicaid recertification.

4. Assist with other duties assigned by the Social Work Manager or Department Head.

REQUIREMENTS:

1. Must have a High School Diploma or equivalent.

2. Two years of experience working in an administrative or clerical role or an equivalent combination of training and relevant experience.

3. Must be Bilingual (English/Spanish).

---