RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

• Initiates Medicare, Social Security, Long-Term Care Medicaid Waiver application process for potential participants, including application completion, assisting applicants with gathering and processing verification items, application submission, and coordination with SEP case managers, tracking and follow-up of application status
• Provides initial telephone point of contact with potential participants and participants family/care giver and referral sources as needed
• Completing home visits as necessary to aid in the process of establishing and then maintaining eligibility
• Regularly checks Colorado Benefits Management System (CBMS) or visits DHS office to obtain eligibility status on eligible and enrolled participants and updates tracking sheets
• Conducts consistent professional written and verbal communication with referral sources, and documents these communications in the Electronic Health Record
• Requests and tracks requests for records and other required paperwork from doctors offices, and other sources
• Maintains Medicaid Tracking database including tracking time to approval from submission to approval by DHS, and all other statuses as needed/required
• Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format
• Prepares the DSS-1s from DHS and tracks the participants recertification (RRR) with DHS to make sure they are approved year to year
• Prepares the Continued Stay Review (CSR) packet and tracks the participants CSR in coordination with SEP
• Supports RMHCS finance department in validation of Medicaid payments and revenue cycle as needed and requested by Management
• Completes and records initial and annual verifications of participants incomes
• Maintains and updates participant shared payments for Assisted Living Facilities (ALF) or Skilled Nursing Facilities (SNF)
• Coordinates intake of new participants as necessary
• Maintains professional affiliations and any required certifications
• Performs other duties as assigned

ORGANIZATIONAL (CORE RATING FACTORS):

• Demonstrates support of the Companys Mission, Vision and Core Values
• Provides Exceptional Customer Service
• Ensures discretion with confidential information in accordance with HIPAA guidelines
• Supports a collaborative work environment including courteous, helpful and professional behavior
• Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
• Adheres to and supports all Company policies and procedures
• Supports and practices safe work habits in accordance with policies and procedures
• Brings ideas, problems and concerns forward and participates in resolution and implementation
• Participates in and completes regulatory compliance trainings within the prescribed deadlines
• Attends required meetings
• Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency

QUALIFICATIONS AND REQUIREMENTS:

• Associates degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of DHS, Medicaid, VA, and Social Security processes
• Certified Medicaid Professional (CPM) highly desired
• Extensive knowledge of community resources available to seniors and their families
• Case Management experience highly desired
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• 1 year experience working with the frail and/or elderly populations preferred
• Experience working with an Electronic Health Record preferred

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Requirements This job operates in an office environment and is largely a stationary position (over 50% of the time), however, some filing is required. This requires to the ability to move files, filling out paperwork and bending/standing as necessary. Operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer for nearly the entire work-day. Requires the ability to read paperwork, computer screens and communicate effectively through use of verbal and/or written forms. This role often is required to position oneself in a kneeling, bending, or crouching position to reach, install, or remove computer equipment. Requires the ability to move boxes, files, supplies/equipment, etc up to 15 pounds using appropriate body mechanics.

Environmental Conditions This role operates in a closed office environment. Work-space may be shared. Working conditions may be noisy with fluctuating indoor temperatures. May be exposed to a risk of bodily injury through contact with moving instrumentation, substances and other conditions common to an office environment. This job requires working under stressful conditions. Moderate pressure to meet scheduled and recurring deadlines.

REPORTS TO: Intake and Enrollment Supervisor

FLSA Status: Non-Exempt

QUALIFICATIONS AND REQUIREMENTS:

• Associates degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of DHS, Medicaid, VA, and Social Security processes
• Certified Medicaid Professional (CPM) highly desired
• Extensive knowledge of community resources available to seniors and their families
• Case Management experience highly desired
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• 1 year experience working with the frail and/or elderly populations preferred
• Experience working with an Electronic Health Record preferred