Medicaid Enroll & Outrch Spc II

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

350 Parrish St, Canandaigua, New York, United States of America, 14424

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500169 Medicaid Enrollment

Work Shift:

UR - Day (United States of America)

Range:

UR URCA 208 H

Compensation Range:

$24.22 - $31.49

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

GENERAL PURPOSE
In addition to the duties of Medicaid Enrollment and Outreach Specialist (MEOS I), MEOS II supports the Medicaid Enrollment Department’s standards of practice through mentoring and assisting MEOS 1 staff to develop their expertise in procuring public entitlements for University of Rochester Health System patients. MEOS IIs possess advanced knowledge of all aspects of Medicaid, are proficient in research, interpretation and application of Medicaid regulation to the benefit of our patients. They demonstrate independence in complex problem solving, prudent judgement and can successfully manage a higher volume of demanding cases with limited direction from their Operations Supervisor.

ESSENTIAL FUNCTIONS

Benefit Management:

• Provides outreach services to patients referred by University of Rochester Health System staff through face-to-face interaction, telephone contact and home visitation for patients requiring assistance with benefit application. 
• MEOS IIs demonstrate a high degree of proficiency and discretion in determining the most beneficial means of applying for benefits via computer systems and/or paper application.
• They may accompany or represent the patient at eligibility interviews, case conferences or fair hearings
• They possess the ability to independently manage a complex caseload and efficiently coordinate high volume of work.  
• Demonstrates higher understanding of budgeting methodologies and requirements for institutionalized persons.

Referral Coordination:

• Understands criteria for appropriate referrals and can provide feedback to internal customers to assure complete and relevant referrals via the FAM.
• Exercises prudent, independent judgment when prioritizing and resolving referrals.
• Consistently communicates, coordinates and enhances professional relationships with internal departments: Health Insurance Counseling, Social Work/Placement Office, Patient Financial Services, Financial Assistance Program, RIM, Office of Counsel and Clinicians. External coordination includes families, community physicians, Department of Social Services, Department of Health, Nursing Home Admissions/Billing Depts, Social Security, Veterans’ Administration, Homeland Security, advocacy groups and other agencies. 

Monitoring Caseload, Documentation, Reports, Mentoring:

• MEOS II exhibits efficiency and skill in monitoring their caseload and documenting timely and accurately in requisite systems: 
• Financial Assistance Module, EPIC, NYSOH application.
• Possesses ability to independently manage caseload; MEOS IIs review productivity reports and prepare status updates as required by management; MEOS IIs independently resolve Exhibit 50 Report/discrepancies.
• Through shadowing and mentoring they avail their accumulated expertise to newer MEOSs to accelerate and fortify MEOS I skill acquisition (which can include outreach, patient interaction, securing applications and documents)
• Authorized to approve closure of MEOS I referrals with self-pay balances < $5,000.

Problem Resolution:  

• Capable of discerning and addressing consequential barriers to securing public benefits which may impact hospital reimbursement and timely discharge.  
• Possesses a nuanced understanding of reliable case presentation
• Models and encourages this skill to MEOS I.
• Identifies problems requiring supervisory intervention.
• Demonstrates prudent judgement and embraces continuous learning opportunities.