Medicaid LTC Financial Eligibility Case Reviewer
About the position
The Case Reviewer supports the processing of Financial Eligibility determinations and Redeterminations for those seeking New Hampshire Medicaid Long-Term Care assistance. In this role, incumbents process financial eligibility applications effectively and efficiently to facilitate timely determinations and redeterminations, and ultimately, access to long-term care to improve the well-being of those seeking LTC services.
Responsibilities
ā¢ Manage assigned caseload and complete all eligibility determination tasks within State-specified timelines, while upholding State, Federal, and PCG confidentiality and security protocols and policies.
ā¢ Maintain accurate and timely documentation of applicant information using State case management and eligibility systems
ā¢ Review assigned cases for completion and identify whether additional documentation or information is needed to make eligibility determinations or redeterminations.
ā¢ Schedule and conduct virtual interviews with applicants to review and confirm application documentation and information.
ā¢ Provide education to applicants and their representatives around financial eligibility criteria and any additional documentation required.
ā¢ Use provided checklists, tools, and decision trees to verify whether documentation demonstrates applicants meet State and Federal financial eligibility criteria.
ā¢ Utilize State case management systems, checklists, and verification tools to develop and submit eligibility recommendations in accordance with State policy and federal Medicaid rules.
ā¢ Receive and process calls and electronic inquiries (email, phone, fax) related to application status, documentation questions, timelines, and next steps.
ā¢ Support supervisor with correcting errors identified during quality assurance audits
Requirements
ā¢ Ability to work independently and collaboratively in a remote team environment.
ā¢ Ability to gain in depth understanding of New Hampshire Medicaid long-term care financial eligibility criteria and apply these principles to applications.
ā¢ Ability to use independent decision-making on the appropriate processes to follow, information to process, and actions to take in accordance with standard procedures with limited supervisory direction.
ā¢ Ability to explain processes, documentation requirements, and complex eligibility rules to applicants with a diverse range of communication and functional skills.
ā¢ Competency in applying quality customer service principles
ā¢ Strong organizational, documentation, and problem-solving skills.
ā¢ Excellent communication and interpersonal skills, with sensitivity to diverse populations.
ā¢ High school diploma, or equivalent required.
ā¢ Must be 18 years of age or older.
ā¢ 1-3 years of experience performing reviews for public programs with eligibility requirements.
ā¢ Ability to speak, read, and write English clearly and concisely.
ā¢ Employment is contingent on completion of a background check.
ā¢ Must have a private space with no distractions and reliable, high speed internet connection.
Nice-to-haves
ā¢ Familiarity with Federal and New Hampshire Medicaid financial eligibility regulations and processes preferred.
ā¢ Some college training preferred.
ā¢ experience with Medicaid or Medicaid LTC eligibility preferred.
Benefits
ā¢ Health, vision, and dental insurance
ā¢ 401(k) with discretionary employer match
ā¢ Paid time off and holidays
ā¢ Flexible spending accounts
ā¢ Other Perks
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Apply To this Job
The Case Reviewer supports the processing of Financial Eligibility determinations and Redeterminations for those seeking New Hampshire Medicaid Long-Term Care assistance. In this role, incumbents process financial eligibility applications effectively and efficiently to facilitate timely determinations and redeterminations, and ultimately, access to long-term care to improve the well-being of those seeking LTC services.
Responsibilities
ā¢ Manage assigned caseload and complete all eligibility determination tasks within State-specified timelines, while upholding State, Federal, and PCG confidentiality and security protocols and policies.
ā¢ Maintain accurate and timely documentation of applicant information using State case management and eligibility systems
ā¢ Review assigned cases for completion and identify whether additional documentation or information is needed to make eligibility determinations or redeterminations.
ā¢ Schedule and conduct virtual interviews with applicants to review and confirm application documentation and information.
ā¢ Provide education to applicants and their representatives around financial eligibility criteria and any additional documentation required.
ā¢ Use provided checklists, tools, and decision trees to verify whether documentation demonstrates applicants meet State and Federal financial eligibility criteria.
ā¢ Utilize State case management systems, checklists, and verification tools to develop and submit eligibility recommendations in accordance with State policy and federal Medicaid rules.
ā¢ Receive and process calls and electronic inquiries (email, phone, fax) related to application status, documentation questions, timelines, and next steps.
ā¢ Support supervisor with correcting errors identified during quality assurance audits
Requirements
ā¢ Ability to work independently and collaboratively in a remote team environment.
ā¢ Ability to gain in depth understanding of New Hampshire Medicaid long-term care financial eligibility criteria and apply these principles to applications.
ā¢ Ability to use independent decision-making on the appropriate processes to follow, information to process, and actions to take in accordance with standard procedures with limited supervisory direction.
ā¢ Ability to explain processes, documentation requirements, and complex eligibility rules to applicants with a diverse range of communication and functional skills.
ā¢ Competency in applying quality customer service principles
ā¢ Strong organizational, documentation, and problem-solving skills.
ā¢ Excellent communication and interpersonal skills, with sensitivity to diverse populations.
ā¢ High school diploma, or equivalent required.
ā¢ Must be 18 years of age or older.
ā¢ 1-3 years of experience performing reviews for public programs with eligibility requirements.
ā¢ Ability to speak, read, and write English clearly and concisely.
ā¢ Employment is contingent on completion of a background check.
ā¢ Must have a private space with no distractions and reliable, high speed internet connection.
Nice-to-haves
ā¢ Familiarity with Federal and New Hampshire Medicaid financial eligibility regulations and processes preferred.
ā¢ Some college training preferred.
ā¢ experience with Medicaid or Medicaid LTC eligibility preferred.
Benefits
ā¢ Health, vision, and dental insurance
ā¢ 401(k) with discretionary employer match
ā¢ Paid time off and holidays
ā¢ Flexible spending accounts
ā¢ Other Perks
Apply tot his job
Apply To this Job