Medicaid Eligibility Policy Specialist

2 weeks ago


Bedford, United States SLP Operations, LLC Full time

At SLP, our commitment is to provide love, attention and optimal care one resident at a time. We realize consistently fulfilling this commitment depends on the success of professionals like you, who build their careers with us. Together, we're setting the standard in the delivery of rehabilitation, quality post-acute services and long-term care.

Your talent will make a difference every day and we will make it count for you

Career Advantages We Offer:

•Medical, vision and dental insurance

•Employer-paid life insurance

•Paid time off

•Paid holidays

•Flexible schedule

•Long term growth and advancement opportunities

•And more....

Job Summary:

This role provides highly experienced HHSC Eligibility Policy and Process knowledge and compliance support for SLP. This role is responsible for supporting the Medicaid Eligibility Process for post- acute and Long-Term care patients to maximize patient care benefit access and revenue cycle outcomes by ensuring adherence to HHSC Eligibility Guidelines

Responsibilities:

  • Partners with Eligibility Specialists to ensure application success through, education, training, and case review.
  • Serves as a policy and guideline specialist for patients and SLP team members regarding Medicaid Eligibility Programs and carve outs.
  • Screens SSI pending and Medicaid pending referrals to ensure eligibility is obtainable once admitted.
  • Monitor industry and regulatory changes regarding Medicaid Eligibility to ensure compliance and provide recommendations for process improvement.
  • Review all denials to determine if properly denied or need to appeal.
  • Partners with Medicaid Eligibility Manager to perform and track Medicaid process and policy integrity audits and resolve escalation issues.
  • Performs recovery functions to obtain Retroactive Medicaid Coverages.
  • Complete Medicaid applications/renewals as needed.
Requirements
  • 4 or more years of experience RCM Process Management
  • High School Diploma, GED
  • Computer Skill and Excel proficiency
  • Microsoft Office, Adobe, SharePoint- Microsoft 365
  • Vizio and PowerPoint
  • Previous experience as a Long-Term Care Regional or Corporate Eligibility Manager required
  • Extensive Knowledge of the HHSC Eligibility Handbook Policies
  • Must be able to foster and maintain good working relationships with cross functional teams
  • Ability to communicate effectively at all levels within the company to include, but not limited to, patients, family members, attorneys, and HHSC Medicaid Eligibility Workers (OWPs)


We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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