The Medical Assistance Eligibility & Authorizations Specialist is a position within the Finance Department and is directly accountable to the Controller.
This position is responsible for the oversight, processing, and support of Pennsylvania Medical Assistance/Medicaid (MA) eligibility/renewals for the consumers of Step By Step, Inc. within all of the Organization’s regions. Functions supported include Accounts Receivable/Billing and Client Financial Supports.
With respect to the consumer MA eligibility and renewal process, the individual will work closely with the Finance Generalist-Liaison, Finance Generalists within the regions, Accounts Receivable supports, consumer representative payees, County Assistance Offices, Administrative Entities, and Supports Coordinators. The individual will spearhead all efforts to maintain consumer MA eligibility and will function as a liaison for technical support in this regard between Program Operational Activities and the Finance Department. The individual will be familiar with all related Finance Department policies and procedures.
ESSENTIAL FUNCTIONS
PA Medical Assistance/Medicaid (MA)- Maintenance of Consumer Eligibility and Benefit Renewals
Functions as the point person/lead oversight to ensure consumer Medical Assistance (Medicaid) eligibility is maintained and that consumer resource information is obtained to support the filing of timely and accurate consumer MA applications.
Directly prepares consumer MA renewals as well as assist and guide Regional Financial Generalists, as applicable, in completing Medicaid renewals, providing technical expertise and support throughout the entire process.
Verifies consumer information utilized for the MA application/renewal process against supporting documentation, databases, and interviews.
Verifies the completion of MA applications/renewals are made in accordance with established program guidelines and regulations.
Follows up on denied MA applications/renewals and provides the next steps to re-establish eligibility, including the exercise of appeal options.
Maintains accurate and confidential case records in compliance with HIPPA.
Stays up-to-date with respect to MA policy changes affecting eligibility requirements.
Troubleshoots and resolves unique issues that arise during the Medicaid renewal process, ensuring compliance and continuity of services.
Works with the consumer and/or representative payee, program management, and the AR Department in instances of consumer eligibility lapses as a result of being over resourced. Sees the process through of the spend down of consumer funds (Private Pay status) until such time as the consumer once again becomes MA eligible and reapplication for benefits is submitted.
Trains on an as needed basis, Regional Financial Generalists on key systems, including COMPASS, PROMISe, and HCSIS, as needed to enhance operational efficiency.
Maintains a rapport with third party legal resources, administrative entities, County Assistance Offices, and Supports Coordinators in order to address technical consumer MA eligibility needs as they arise.
Billing and Accounts Receivable
Oversees, maintains and updates the Client Control Log and PUPS (fields/forms) to ensure accurate and timely records in furtherance of consumer MA eligibility maintenance.
Provides assistance in the review of open accounts receivable
Provides assistance in the monitoring of collection efforts in order to ensure the prompt collection of receivables.
Provides assistance with consumer service authorizations/authorization of unit shortages within each region. Assists with the contacting and follow up with Supports Coordinators and Service Directors.
Client Financial Records and Small Funds Support
Provides support and assistance to Finance Generalists with respect to room and board contracts, client rent rebate applications and SNAP applications.
Assists consumers with the establishment of a representative payee on an as- needed basis.
Assists consumer/representative payee with the establishment of consumer burial reserve accounts, PA ABLE accounts, and provide support for the establishment of, and address, Power of Attorney (POA) and guardianship issues and concerns as applicable needs arise.
Other Support
Supports and identifies MA eligibility training requirements for program operations team.
Helps to disseminate MA eligibility technical requirements and information to sites, staff, clients, and representative payees as necessary.
Other duties as necessary and assigned with respect to general Finance and Accounts Receivable supports.
MINIMUM QUALIFICATIONS/REQUIREMENTS
(Education and/or Experience/Physical Demands/Other Skills and Abilities)
Education and/or Experience:
Strong working knowledge of MA program policy and regulations is a must.
Three years of experience with the intricacies of the PA Medical Assistance/Medicaid (MA) eligibility/renewal process and MA application submissions or such strong working knowledge of MA policy and regulations in combination with performing bookkeeping or clerical accounting work, or
A bachelors degree in accounting or business administration and two years of experience working with MA requirements and intricacies in combination with bookkeeping or accounting work or
Any equivalent combination of experience and training.
Physical Demands:
Must be physically able to continually operate a PC or computer terminal for at least one hour or longer at a time.
Must be physically able to lift boxed documents and/or other objects weighing up to approximately 15 pounds.
Must be able to operate a calculator, stapler, three-hole punch, copier, fax machine, etc.
Other Skills and Abilities:
Must be self-motivated, highly ambitious, and an independent thinker.
Must be highly organized.
Must be proficient in data entry.
Must be an excellent communicator.
Must be able to operate and view screen information on a PC and/or computer terminal.
Must be able to read, write, and speak the English language.
Must have some knowledge of Microsoft Word and Excel.
Must be able to develop and maintain effective working relationships with all levels of personnel within and outside of the agency.
Must always maintain confidentiality and handle sensitive consumer information with discretion.
Must be able to always present a professional attitude when dealing with co-workers, management and outside contacts.
Must be able to maintain a pleasant demeanor on a consistent basis to remain open and accessible to all co-workers, management, staff and outside contacts.
Must possess good analytical and problem-solving abilities.verview
Pay: $51,000.00 - $53,000.00 per year
Work Location: In person
