Entitlements Specialist

POSITION TITLE: Entitlement Specialist 

POSITION SUMMARY: The Entitlements Specialist is responsible for Medicaid/Intake applications, follow-up for Human Resources Administration (HRA) applications and Pending Medicaid, SSI/Fair Hearing appointments and Managed Care (HMO) dis-enrollments and distribution of EFSP Funds. Maintain efficient filing system for active OTP, 822, and Wellness.

A. ENTITLEMENTS:

· Responsible for Medicaid/Intake Applications for new clients and re-application for those clients who have lost Medicaid Benefits. This includes collecting the required documents from the clients (such as Birth Certificate, Social Security Card, etc.), filling in the application forms, and making appointments for clients to go to the Medicaid/HRA Center to attend the face-to-face Medicaid/HRA Interviews.

· Create folders for new admissions (OTP, 822, and Wellness).

· Maintain copies of documents/intake finance statements and Medicaid/HRA applications for backup and file it in the client folders.

· Maintain client folders with updated progress notes on face-to-face contact, pending Medicaid/HRA/Fair Hearing letters and representative/counselor contacts.

· Monthly review, removal of discharge client folders from active filing and maintain discharge clients filing system for storage.

· Verify the eligibility status of clients Medicaid through scanning, if Medicaid is ineligible, client folders must be maintained in pending file for monitoring.

· Ensure each pending folder has the last Medicaid payment copy and date of ineligibility information/Medicaid denial.

· Verify clients’ insurance and update information/new Medicaid CIN numbers in URS for VIP programs.

· Maintain a filing system for clients transferred to Self-Pay forms.

· Produce and distribute weekly client reports to selected staff on ineligible Medicaid, Medicaid pending and needed counselor intervention.

· Request Fair Hearing/SSI appointments for Medicaid eligibility and Managed Care (HMO) dis-enrollments.

· Responsible for reviewing Medicaid restricted clients and getting appropriate approvals.

· Responsible for retroactive Medicaid to maximize revenue.

· Responsible for giving the Medicaid resolved clients file to the Senior Biller for re-billing and back billing.

· Responsible for distributing EFSP vouchers, weekly updates to the EFSP report, maintaining filing system, prepare vouchers in a timely manner for check request and approval to pay vendor.

· Other duties as assigned by the Director/Manager.

· Responsible for collection of self-pay

B. HUMAN RESOURCES ADMINISTRATION (HRA):

· Responsible for distribution of metro cards to the residential program.

· Responsible for monitoring intake applications of 822, OTP, and Wellness to HRA, face-to-face appointments and EVR appointments.

· Collecting self-pay monies from client’s monthly

· Maintain a liaison with the Human Resources Administration (HRA) to follow up and ensure that client cases are active.

· Responsible for M-75e forms review and filing.

· Responsible for requesting temporary Medicaid cards from HRA and distributes to the clients.

· Responsible for requesting budget letters from HRA for residential clients.

· Responsible for Re-Certification Application, filing, and submitting to HRA in a timely manner.

· Other duties as assigned by the Director/Manag

SALARY: $40,000-$42,000

JOB COMPETENCY:

· Associate Degree or High School Diploma

· 2-3 years related experience

· Medicaid Eligibility Certificate required/ or least 90 after hire

· Computer Knowledge required

JOB REQUIREMENTS/SETTING:

· Must possess sight and digital senses or prosthetics that will enable the essential functions of the job to be completed.

· Performs duties throughout the Agency.

NOTE:

This description reflects management’s assignment of the essential functions. It does not restrict the tasks that

may be assigned. Tasks are subject to change at any time due to any reasonable but necessary conditions.

My signature below indicates that I have reviewed and agreed to comply with the indicated description as discussed with my supervisor: