Medicaid Lead Specialist
This professional staff is 100% Medicaid related and shall perform some or all of the ADRC activities specified below:
The Medicaid Lead Specialist is responsible for assisting with all aspects of the Statewide Medicaid Managed Care Long-Term Care (SMMC) operations of the Aging and Disability Resource Center (ADRC), as specified in the contractual Medicaid duties and responsibilities. This non-exempt position ensures the delivery of streamlined, efficient, and consumer-friendly customer service.
PROGRAM MANAGEMENT DUTIES AND RESPONSIBILITIES:
1. Maintains compliance with all SMMC LTC contractual requirements.
2. Assists with distribution of referrals; Enrollment Management System (EMS) release assignments; assessments; reassessments; follow-up; and, all other SMMC LTC functions, including time management.
3. Assists with comprehensive training for new staff; refresher training for current staff; and, specialty training, as required and as needed.
4. Provides verbal and written technical assistance to Medicaid staff.
5. Monitors all metrics established for performance reports, including staff productivity.
6. Assists with streamlined procedures for the Medicaid eligibility process, including financial determination by the Department of Children and Families (DCF); Level of Care (LOC) determination by the Department of Elder Affairs case managers (CARES); and, releases for enrollment through the Agency for Health Care Administration (AHCA).
7. Provides weekly updates to the ADRC Supervisor on program metrics, tracking trends and reporting issues that need to be addressed.
8. Participates in statewide calls and local partnership meetings with DCF, DOEA/CARES and other entities as determined appropriate to facilitate and enhance the Medicaid eligibility process.
9. Assists with responses to SMMC LTC email correspondence from DOEA and other ADRCs.
10. Provides input for the development and maintenance of SMMC LTC procedures.
11. Assists with outreach efforts in accordance with DOEA policies to increase public awareness of Medicaid programs and services.
12. Provides assistance with data analysis, file review, call monitoring, and other quality assurance measures, as needed.
13. Ensures expedited Enrollment Managements Systems (EMS) releases, including all required procedures; maintenance of a tracking log of all EMS releases in Excel; and, on-going data analysis for weekly reports to the ADRC Supervisor.
14. Reviews and approves all Medicaid staff timesheets and leave requests.
CONTRACTUAL MEDICAID DUTIES AND RESPONSIBILITIES:
Medicaid Outreach and SMMC Long-Term Care Program Education:
1. Counsels individuals on the SMMC LTC program, available services, eligibility requirements, the application process, and additional informational sources.
2. Provides outreach that is standardized and consistent statewide to ensure public awareness of Medicaid programs and services and how to access them.
Medicaid Eligibility Screening and Prioritized Waitlist Placement, including:
1. Accepts referrals from the ADRC Elder Helpline and other sources to complete prioritization screening.
2. Determines the individual’s needs for potential Medicaid-related services eligibility utilizing a standardized screening instrument approved by the Department of Elder Affairs.
3. Provides efficient, timely and consumer friendly services to facilitate the eligibility and review process.
4. Ensures accurate data entry into CIRTS (Client Information Registration Tracking System) and the ReferNet database.
5. Provides individuals or individual’s representatives with accurate information about potential Medicaid eligibility, including their rights and responsibilities.
6. Completes a re-screening for individuals on the prioritized waitlist using a standardized screening instrument as required or requested due a reported significant change.
Enrollment Management System (EMS), including:
1. Follows all DOEA EMS release procedures, as outlined in the current EMS procedures manual.
2. Contacts individuals on an EMS release verbally and in writing.
3. Verifies an individual’s current Medicaid eligibility status for purposes of the Medicaid eligibility process.
4. Explains Medicaid eligibility rules and the Medicaid eligibility process to prospective applicants.
5. Works with individuals to obtain the Physician Referral Form (AHCA 5000-3008).
6. Ensures required EMS related data is entered into CIRTS and ReferNet timely and accurately.
7. Coordinates with DOEA CARES (Comprehensive Assessment and Review for Long-Term Care Services) staff for determination of medical eligibility.
8. Assists individuals with acquiring forms and compiling required documentation; technical assistance; eligibility determination; and, all other duties related to completing and submitting a Medicaid application.
9. Tracks Medicaid applicants through the eligibility process.
10. Assists individuals by coordinating with DOEA/CARES and DCF/ESS staff to resolve any eligibility issues that arise during the Medicaid eligibility determination process in a timely manner.
11. Assists individual callers who have lost SMMC LTC Medicaid benefits to regain eligibility for program re-enrollment, as allowed by DOEA EMS procedures.
Grievance and Complaints, including:
1. Provides assistance to SMMC LTC enrollees concerning how to file grievances and complaints with the long-term care plans.
2. Provides information concerning Medicaid Fair Hearings.
3. Follows Independent Consumer Support Program (ICSP) procedures for assisting SMMC LTC enrollees with informally resolving grievances with long-term care network and accessing the long-term care network’s formal grievance process.
4. Maintain records of such complaints, in accordance with statewide procedures.
Quality Assurance, including:
1. Completes quality assurance reviews of 701S and SMMC long-term care education contacts by ADRC Medicaid staff.
2. Assists in ensuring CIRTS data accuracy and integrity.
3. Assists with tracking and reviewing EMS processing to ensure contractual compliance.
EDUCATION and/or EXPERIENCE:
1. Master’s Degree from an accredited college or university in a human services related field; or
2. Bachelor’s Degree from an accredited entity in a human services related field and a minimum of two years of related work experience.
1. Experience working in a customer service centered or contact center environment;
2. Knowledge of computer applications to perform the functions of the position, including word processing, database, and spreadsheet applications;
3. The ability to work independently and with minimal supervision;
4. Knowledge of available ADRC administered programs and available Medicaid programs;
5. The ability to work with disabled adults, elders, caregivers, stakeholders, and community partners in a knowledgeable, engaged, and compassionate manner; and the ability to set and track personal performance goals to efficiently manage workload.
6. Experience in performing supervisory functions, including hiring and training new staff; performance management and coaching, workload management, etc.
7. The ability to conduct training, including public speaking and developing training materials;
8. The ability to effectively communicate both verbally and in writing; and
9. The ability to gather and analyze systems data.
1. Must pass a Level II criminal background screening, must sign Medicaid Attestation Payroll Form per Department of Elder Affairs/Senior Resource Alliance requirements. Must sign SMMC LTC Program “Prohibited Activities” form.
2. Must complete and pass DOEA 701B Assessment Training and testing.
3. Must complete and pass ADRC LTCPE Certification Training and survey.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the activities are required of the employee:
The employee may occasionally lift and/or move up to 10 pounds. No special vision requirement.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the environment is usually moderate.
The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.
To Apply: Qualified candidates should sent their resume to with the job title listed in the subject line – mention CFEC.org job posting.