Location: Long Bch / California
Employment type: Full-Time
Job Description
Job Summary
Provide screening of candidates toward identification of qualified, eligible prospects related to both long-term care needs and Medicaid coverage for enrollment. Assist our current members with renewing Medicaid coverage and ensure that all program participants are enrolled in and maintain all applicable benefits and entitlements.
Knowledge/Skills/Abilities
- Outreach prospects who may qualify for enrollment
- Conducts pre-screening for prospect Medicaid eligibility to assist prospect/member with Medicaid eligibility/coverage
- Participates in the care team for continuous performance improvement: facilitates problem-solving for performance improvement; contributes to the team’s efforts to every member with respect, courtesy and fairness in a way that provides superior customer service
- Educates and provides assistance to members and/or families with the completion and submission of Medicaid re-certification applications for potential and active members as needed via telephone and home visits.
- Assists members with Medicaid re-certification package.
- Educates, verifies, and gathers budget information and documents for members who have surplus or pooled trust.
- Conduct home visits as needed to assist in completion of documents.
- Submit documentation to state agency within specified time-frame to assure Medicaid coverage for participant.
- Tracks the Medicaid eligibility status via state agency’s system and Medicaid hotline for all prospect and active members. Assists internal teams in verifying Medicaid eligibility through state agency enrollment system.
- Monitors Medicaid re-certification time frames for each active member and maintain records on coverage status and recertification.
- Documents all member contact and documentation regarding recertification in appropriate system.
- Notifies member of upcoming loss of eligibility and assists in safe transition for disenrollment.
- Maintains the highest level of integrity, courtesy, and respect while interacting with prospects and active members, employees, and business contacts.
- Excellent communication, interpersonal, decision-making and customer service skills for frequent interaction with prospects and active members and internally with other business associates.
- An independent thinker with a history of creating solutions to achieving goals with ability to work in a continuous quality improvement mode
- Aptitude for using a fast-paced proactive vs. reactive approach maneuvering multiple tasks simultaneously including seamlessly changing priorities.
- Significant electronic records management capabilities for moving around in a database and entering information.
- Technical skills in e-faxing, electronic archiving or encryption.
- Knowledge of current community health practices for the frail adult population and/or cognitively impaired seniors including the values offered with integrated care.
Job Qualifications
Required Education:
- High School Diploma or equivalent
Preferred Education:
- Associates Preferred
Required Experience:
- 2+ years of experience with Medicaid eligibility, screening, application process, review, determining eligibility, recertification or processing.
- Proficiency in navigating the internet and multi-tasking with multiple software / electronic documentation systems simultaneously.
- Experience with a Corporate email system including calendar functionality, as well as Microsoft.
- Role specific industry experience in Long-Term (LT) or Managed Long-Term Plan (MLTCP).
- Experienced in one or more of the following additional areas: health insurance, home care environment, acute or sub-acute
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.