Manager, Medicaid Eligibility

Job Purpose
The Manager, Medicaid provides support and direction to the department’s team members. They will lead the division in determining Medicaid eligibility for patients of our client hospitals and in providing assistance to patients in completing the Medicaid application process. The Manager, Medicaid works under limited supervision. They must be able to identify issues that arise, determine the appropriate course of action, and communicate problems when necessary to management for further resolution. The Manager, Medicaid must perform all duties in accordance with HIPAA, the Firm’s and Medicaid guidelines at all times.

Duties and Responsibilities
• Confirm patients’ eligibility for Medicaid by reviewing account notes in the department’s proprietary database
• Review completed applications to expedite the submission process
• Draft submission letters, emails and texts
• Post approval, review submission to make sure that all protocols were properly followed
• Track deadlines using Excel
• Create and review various reports on a continual basis
• Access hospital databases to obtain information needed for claims and reporting
• Communicate with the Department of Social Services to address any concerns or questions in relation to any submissions
• Review cases in the database to ensure statuses are up to date and accurate
• Deliver continual feedback to management for on-going processes and workflow improvement
• Request changes to workflow based on business needs with IT
• Assist in the development of protocols
• Prepare cases to be closed and notify the appropriate team members of their closing
• Responsible for the maintaining of the department’s allocated budget
• Coordinate team meetings and arrange any team events
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Qualifications
• Associates degree or higher required
• Must have held a managerial position, preferably within the customer service field for at least 3 years with the ability to supervise others
• Experience with ePACES and LexisNexis is a plus
• Bilingual English/Spanish preferred
• Be able to effectively communicate with third parties
• Proficient in Microsoft Office applications (Excel, Word and Outlook)
• Good planning and implementation skills
• Strong investigatory, researching and problem-solving skills
• Excellent written and verbal skills
• Must have administrative experience
• Ability to efficiently multitask
• Possess a high level of organization skills and be detail-oriented
Working Conditions
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.