Nursing Home Medicaid Specialist
2 months ago
Hewlett
Job Overview We are seeking a dedicated and detail-oriented Nursing Home Medicaid Specialist to join our team. In this vital role, you will serve as a key resource in navigating the complex Medicaid reimbursement process for nursing home residents. Your expertise will ensure compliance with state and federal regulations, facilitate accurate documentation, and support residents' access to necessary benefits. This position offers an exciting opportunity to make a meaningful impact on patient care and facility operations through proactive case management and thorough knowledge of healthcare policies. Duties • Review and interpret medical records, discharge summaries, and clinical documentation to determine Medicaid eligibility for nursing home residents, • Collaborate with social workers, healthcare providers, and discharge planners to gather necessary documentation and ensure timely processing of Medicaid applications, • Conduct intake assessments, verify patient information, and facilitate the submission of Medicaid claims in accordance with state guidelines, • Utilize CPT (Current Procedural Terminology) coding, ICD-9, and ICD-10 coding systems to accurately classify diagnoses and procedures for billing purposes, • Maintain comprehensive medical records, ensuring HIPAA compliance and confidentiality at all times, • Assist with case management by coordinating services, supporting discharge planning, and addressing behavioral health or pediatric needs when applicable, • Proven experience in hospital or healthcare settings, particularly with acute care environments or discharge planning processes, • Strong knowledge of medical terminology, CPT coding, ICD-9/ICD-10 coding systems, and medical records management, • Familiarity with social work practices, behavioral health considerations, pediatrics (if applicable), and patient service protocols, • Understanding of HIPAA regulations to safeguard patient information during all stages of case management, • Excellent organizational skills with the ability to manage multiple cases efficiently under tight deadlines, • Effective communication skills to collaborate across multidisciplinary teams and explain complex processes clearly
Jonah G.Active 1 month ago