Medicaid Specialist TCOOMMI

Medicaid Specialist TCOOMMI

TCOOMMI Medicaid Specialist

Job Code: MS - 107

Revision Date: February 24, 2026

Starting Salary: $15.30 hourly; $31,816 annually

FLSA: Non-Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.


General Description

The purpose of this job is to performs administrative/clerical duties for the Benefits Assistance Program to include local travel to outpatient clinics and court mandated hearings, as scheduled.? Assists consumers with chronic mental illness and/or IDD in obtaining Social Security Disability Benefits through clear, effective and efficient Medicaid Policy, Programs and Billing. This job involves fact checking, record keeping and advocacy on behalf of their clients.? It follows established policies & procedures.? Places priorities in assisting consumers obtain Supplemental Security Income/Medicaid.


This class works under close supervision according to set procedures.


Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

• Performs standard office support by answering phone, greeting customers, and schedule patient appointments.
• Obtains medical records from the Outpatient Clinics and submit them to Social Security Administration, DDS or ODAR.
• Requests necessary information to determine eligibility in an accurate and timely manner, to include, but not limited to, the completion of the Screening for SSA and Medicaid Eligibility Assessment.
• Ensures all state requirements are met, as well as securing all required documentation.
• Processes Medicaid claims through the Community Partnership with HHSC.
• Enrolls clients requesting the Affordable Healthcare Insurance.
• Maintains confidentiality of all business matters.
• Processes monthly reports for the consumers served.
• Monthly follow-up calls for SSA case status and documenting per program guidelines in electronic health records and TDCJ database, where applicable.
• Obtain documentation and capture signatures from consumers served
• Serve as a back up to the Lead Medicaid Specialist.
• Processes all initial and follow-up claims for the clients at their assigned units, as applicable.
• Completes correspondence for consumer's medical requests (SSA correspondence, etc.), as needed or applicable.
• Assists assigned clients in completing the ADL's and Work History Reports within 2 weeks of receipt, as needed/applicable.
• Confirms the Consultative Exams their assigned clients have pending and report to DDS that the clients will attend the consultative examination, as needed/applicable.
• Compliance with all Joint Commission training requirements relevant to job, those dealing with use of restraints and physical holding of individuals receiving services. Maintains compliance with required federal/state/corporate mandates and regulations.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires a High School diploma or GED supplemented by two (2) years of experience working with claims processing, insurance, office administration or related field; or equivalent combination of education, training, and experience which provides the required knowledge, skills, and abilities.


Experience with trauma-informed services; cognitive behavioral therapies, including Dialectical Behavioral Therapy (DBT); and motivational therapies including the use of incentives, preferred.


Required Knowledge and Abilities

Knowledge of trauma-informed theories, principals, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.


Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.


Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
• Bright/dim light; Dusts and pollen.
• Extreme heat and/or cold; Wet or humid conditions.
• Extreme noise levels, Animals/wildlife.
• Vibration; Fumes and/or noxious odors.
• Traffic; Moving machinery.
• Electrical shock; Heights.
• Radiation; Disease/pathogens.
• Toxic/caustic chemicals; Explosives; Violence.
• Other extreme hazards not listed above.

Special Certifications and Licenses

• Required to obtain HHSC Medicaid Certificate within the first 90 days of employment.
• Must possess and maintain a valid state Driver License with an acceptable driving record.
• Must be able to pass a TB, criminal background and drug screen

Americans with Disabilities Act Compliance (ADA)

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.


Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally-competent and recovery-oriented care.
• Responsible for adhering to the EHN common purpose and service framework to continuously provide exceptional care to all constituents.

Note: This Class Description does not constitute an employment agreement between Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.