Entitlement Specialist Medicaid Liason -ED534817

Job Description

Job Description

JOB SUMMARY:

Takes direction from the Entitlement Services Supervisor Medicaid and Medicare cases Support in the carrying out of assignments that include the processing, maintenance and completion of the following Entitlements Specialist /Medicaid Liaison Coordinator job tasks and responsibilities.

ESSENTIAL JOB FUNCTIONS:

As a Medicaid Liaison Coordinator job tasks and responsibilities include:

• The Medicaid Liaison Coordinator represents Medicaid consumers’ cases at the Clients’ Representative Unit at Medicaid office according to the Protocol Submissions to Clients’ Representative Unit for agencies approved to submit centrally.
• The Medicaid Liaison Coordinator assists Entitlements Specialists in preparation of consumers’ Medicaid cases for processing at Medicaid office.
• The Medicaid Liaison Coordinator follows up cases at Medicaid office either via phone or in person until Medicaid issue is resolved.
• The Medicaid Liaison Coordinator researches and learns the complex rules and regulations of operation of various Units within Medicaid system: Clients’ Representative Unit, Medicaid Surplus unit, Third Party Insurance and Nursing Home Division, Long Term Care Unit and Medicaid Eligibility Unit and deliver this information to Entitlements Department.
• The Medicaid Liaison Coordinator assists Entitlements Specialists in navigating Medicaid complex system to ensure compliance with requirements of Medicaid, Medicaid HMO plans including enrollment into Behavioral Health Managed Care Organizations (BHO), Surplus, MSP, and Medicaid Buy-in Programs
• The Medicaid Liaison Coordinator attends by-monthly Medicaid Citywide meetings and make Entitlements Department aware about discussed issues.
• The Medicaid Liaison Coordinator attends Medicaid trainings
• The Medicaid Liaison Coordinator is able to utilize any type of resources in order to prepare presentations for consumers and clinical staff

MAINTAIN ENTITLEMENT CASE RECORDS: 

• Maintains Entitlement client case records in a timely and accurate manner – the up-to-date filing of all incoming entitlement correspondence, inter- and intra-agency documents and information documents relating to the resident’s entitlement case.
• Maintains an up-to-date and accurate written record, in the Contact Notes section of the client case record, of all Entitlement interactions with residents, and with all the entitlement systems, and inter- and intra-agency contacts pertaining to the resident’s entitlement case.
• Utilizes the Entitlement case record as an analytical tool to be able to efficiently access entitlement information when problems arise and for other purposes, e.g., statistical surveys, departmental reports, etc., and can use this resource to problem solve and to present this information for supervisory review.
• Archives hard-copy files in compliance with records retention policies.
• Maintains all additional ICL Entitlement forms and procedures that may be developed to enhance the full range of maintenance of case records task.

MAINTAIN THE MONTHLY ENTITLEMENTS ACCOUNT RECORDS AND ANY ADDITIONAL ACCOUNTING PROCEDURES THAT ENSURE THAT ALL THE CLIENT’S BENEFITS ARE ACTIVE AND IN PLACE: 

• Maintains an accurate and up-to-date monthly Entitlements programs’ Benefits Amounts spreadsheets. This will be accomplished by the timely recording of all incoming entitlement funds that finance a resident’s program fees plus PNA amounts.
• Utilizes this account record as an analytical oversight tool to ensure ongoing receipt of client eligible entitlement funds and to monitor the flow of client entitlement funds.
• Maintains accurate and up-to-date Direct Deposit records of SSA eligible consumers. The Specialist is responsible for timely processing all necessary paperwork for opening and closing Direct Deposit .
• Scan all copies of the prior month entitlement checks into Entitlements folder.
• Maintains all additional ICL forms and procedures that may be developed to enhance these recording and analytical tasks.

MAINTAIN AND UPDATE THE LATEST DEVELOPMENT IN ENTITLEMENT BENEFITS: 

• The Specialist is familiar with and able to readily use The Public Benefits Research Center (PBRC) Manual.  
• The Specialist can utilize and integrate any new entitlements information accessed using electronic and other media (such as: PDR - the Physician’s Desk Reference, POMS – the collection of SSA rules and regulations, HRA Policy Directives, ACCESS HRA), in his ongoing case management activities. 
• The Specialist can utilize any type of resources to prepare presentations for consumers and clinical staff.
• Maintain the electronic data system and uses e-mail service daily.

MAINTAIN DAILY CLOSE INTERDEPARTMENTAL RELATIONSHIP WITH THE VARIOUS ICL DEPARTMENTS AND IS ABLE TO FULLY UNDERSTAND AND PROCESS THE FINANCE REPORTS AND THE ADDITIOANAL FORMS AND PAPERWORK THAT ARE REGULARLY ISSUED: 

• The Specialist can read and understand the regularly ICL - issued reports and is able to integrate the reported information into his or her ongoing case management activities.
• The Specialist can analyze Finance reports, research individual consumer’s information, and determine further actions.
• Maintain an on-going contacts with other ICL Departments, programs’ staff, clinical managers and doctors to maintain accurate and up-to-date clients’ case management activities.

DEVELOP AND MAINTAIN COLLATERAL CONTACTS: 

• Access, develop and maintain collateral agency contacts and relationships to better process entitlement information and documents to maximize the resident’s entitlement benefits.
• Utilize these collateral agency contacts as an on-going resource for additional entitlement knowledge and as a means of expanding and enhancing the Specialist’s advocacy skills.
• Communicate in an effective manner, both orally and in writing, with wide range of collateral agencies to initiate, maximize and continue the resident’s entitlement benefits and services. Be able to effectively communicate with the highest level of collateral staffs such as: AA to the Director, Supervisor or Manager to ensure the clients’ benefits cases are processed timely and in an efficient manner.
• Serve as a client advocate in front of SSA court and at PA, Medicaid and SNAP Fair Hearings. Collect and process all medical documentation and forms used to help ICL consumers during their Hearings.
• Maintain all additional ICL Entitlement forms and procedures that may be developed to enhance these collateral contact tasks.

PROVIDE ENTITLEMENT COUNSELLING TO RESIDENTS AND CLINICAL STAFF: 

• Maintain scheduled Entitlement counseling meetings for the purpose of providing entitlement outreach and advisement to both residents and staff.
• Specialist should be able to provide individualized benefits advisement services to consumers, which includes collecting the data, analysis and a recommendation to the individual. 
• Can communicate effectively and sensitively with both residents and staff and is particularly attuned to the resident’s varied and changing abilities to process the often difficult and complex entitlement information .
• Maintain all additional ICL Entitlement forms and procedures that may be developed to enhance these counseling and reporting tasks.

ATTEND ALL SCHEDULED ENTITLEMENT SUPERVISORY AND BENEFITS TRAININGS: 

Actively participate in the supervisory process. The Specialist can utilize supervision by taking direction regarding the daily processing and completion of assigned departmental tasks. Through trainings, the Specialist should enhance and expand his entitlement knowledge and the skills necessary to effectively work with residents, agency staffs and the various benefit systems.

Attend various benefits training sessions, be able to understand and comprehend the ever-changing Entitlements operation procedures, relay the subsequent information to the co-workers and utilize it in Specialist’ day-to-day work

QUANTITY AND QUALITY OF WORK STANDARD: 

Regarding all the tasks described above, it is recognized that the pressure of work can often be very intense and that it is often impossible for a specialist’s work to be completed by the end of the usual workday.  Nonetheless, it will be expected that the Entitlements Specialist Coordinator, after a certain time and experience on the job (approximately after the initial six to eight months), will be able to make reasonable judgments as to which tasks should be completed sooner rather than later.   In other words, the counselor should be able, at this point, to prioritize their range of tasks.  The counselor should be able, therefore, to organize a paperwork and case management triage system and process for themselves that will not jeopardize either a resident’s entitlement benefits, or the entitlement revenue returns to the agency.

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES:

• Committed to equity, diversity, inclusion and belonging, and active promotion of the ICL values and goals.
• Excellent verbal and written communication skills along with developed computer literacy.
• Knowledge of Medicaid and Managed Care guidelines.
• Ability to design forms for the collection of information.
• Highly organized and detail oriented.
• Ability to complete tasks in a timely manner.
• Ability to identify problem and analyze.
• Ability to multitask, prioritize work, and perform under stress.
• Willingness to expand knowledge base.
• Positive attitude and excellent customer service skills

QUALIFICATIONS AND EXPERIENCE

Bachelor’s degree (B.A.) plus 2 years’ experience in social/human services (providing services to individuals with psychiatric disabilities a plus), entitlement or related area of service, or Associate degree plus 3 years of above experience, or High School diploma/G.E.D. plus 4 years of above experience.