Medicaid Compliance Officer

1 week ago

Lanham, Maryland, United States Ardmore Full time

The Eligibility Benefits Coordinator plays a crucial role in facilitating communication between the Finance department, LTSS Coordinator, and Services departments. This position is responsible for ensuring that individuals for whom we serve as Representative Payee maintain their eligibility for Social Security, Medicaid, and waiver services. The coordinator will establish a comprehensive tracking system to oversee the timely completion of annual reviews and provide auditing oversight of service documentation to ensure compliance with DDA and waiver standards.

At Ardmore, we are dedicated to our mission of delivering high-quality support services, ensuring that individuals with intellectual and developmental disabilities are treated with respect and given opportunities to engage in community activities and resources.

KEY RESPONSIBILITIES:

  • Develop and sustain a database and tracking system to monitor Medicaid waiver recertification, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Medicare, and associated resources and assets.
  • Oversee Resident Fund Management System (RFMS) accounts to ensure adherence to Medicaid, SSI, and waiver regulations.
  • Conduct Social Security Administration (SSA) reviews, including annual Representative Payee reports, wage reporting, calculation of Impairment Related Work Expenses (IRWE), and annual disability reports.
  • Assist in transitioning from SSI to SSDI for individuals upon retirement of a parent or individual, including applications for Medicare coverage.
  • Maintain Medicaid eligibility and redetermination for all individuals within the Representative Payee program, acting as a liaison with the Division of Waivers Eligibility Services (DEWS).
  • Collaborate with the Nurse Manager and Delegating Nurse to select Medicare D prescription programs.
  • Track DDA waiver eligibility for each individual receiving services, assisting with waiver redeterminations as necessary, and ensuring compliance with waiver program requirements.
  • Support individuals in establishing benefits-protected savings accounts, including Maryland ABLE accounts and Special Needs trusts, while serving as a liaison between these entities and Ardmore.
  • Facilitate the creation of irrevocable pre-needs funeral trusts and person-centered funeral plans that align with individual wishes.
  • Provide guidance and referrals for future and estate planning, participating in meetings with individuals, families, guardians, and teams as required.
  • Work collaboratively with individuals and their teams to identify community-based resources and assist with application and referral processes.
  • Ensure compliance with service documentation by providing oversight of eligibility and service standards.
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:
  • In-depth understanding of SSA benefits and requirements, including SSI, SSDI, and Medicare.
  • Comprehensive knowledge of the SSA Representative Payee program, including guidelines and reporting procedures.
  • Familiarity with community and waiver-based Medicaid programs.
  • Thorough knowledge of DDA Community Pathways and other waiver programs, including eligibility processes.
  • Experience in futures planning, including ABLE accounts and Special Needs Trusts.
  • Preferred: Certification as a Benefits Planner or the ability to complete the certification program successfully.
  • Proficient in technology and software, particularly Microsoft Office Suite.
  • Exceptional written, verbal, and non-verbal communication skills.
  • Demonstrated cultural competency and responsiveness.
  • Ability to adhere to agency requirements, including audits and policies.
EDUCATION AND EXPERIENCE:
  • Associate's degree in Psychology, Social Work, or a related Human Services field is required; Bachelor's degree is preferred.
  • A minimum of three (3) years of experience in claims and benefits eligibility is required.
  • Proficient experience with technology and software, particularly MS Word, Excel, and Outlook.
  • Familiarity with insurance terminology and relevant acronyms is essential.
CONDITIONS OF EMPLOYMENT:
  • Ability to lift and/or move up to 50 pounds.
  • Capability to bend, kneel, push, and pull as necessary.
  • Eligibility for employment within the United States is required.
  • Must maintain a valid driving record and have access to reliable transportation.
  • Compliance with training requirements is mandatory.
  • A clean criminal history is essential.
  • Successful completion of a drug screening is required.
  • COVID-19 Considerations: Ardmore Enterprises enforces a mandatory COVID-19 vaccination policy for all employees, with exemptions available for medical or religious reasons.

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