Medicaid Waiver Specialist

Orlando, FL

SUMMARY:

This professional staff shall perform activities that facilitate access to and the determination of Medicaid eligibility for individuals seeking services.   The counselor expedites the individual’s application for determination of eligibility and participation or maintenance in a SMMLTC Medicaid program.  This entails social service “triage” work, linking high risk elderly clients and their caregivers to Medicaid programs and other support services.  Documentation; client tracking, and reporting are critical components of this position.  The Medicaid Benefits Counselor is an integral part of the ADRC Triage Program and requires an up-to-date knowledge of community resources to ensure appropriate referrals.  This position is 100 % Medicaid-related and shall perform some or all of the following ADRC activities:

ESSENTIAL DUTIES AND RESPONSIBILITIES-MEDICAID BENEFITS COUNSELOR

 

  1. Accept referrals from the EHL as well as other resources for intake and screening.
  2. Determine the individual’s needs and screen for potential eligibility for Medicaid-related services utilizing a standardized screening instrument.
  3. Provide efficient, timely and consumer friendly services to facilitate the eligibility and review process.
  4. Verify an individual’s current Medicaid eligibility status for purposes of the Medicaid eligibility process.
  5. Explain Medicaid eligibility rules and the Medicaid eligibility process to prospective applicants.
  6. Conduct comprehensive screening on Medicaid probable individuals on the APCL who are not active in a case managed program.
  7. Input client assessments into CIRTS (Client Information Registration Tracking System).
  8. Post information in the enrollment and termination screens of CIRTS to update the APCL as needed.
  9. Provide necessary forms and package all forms in preparation for Medicaid eligibility determination.
  10. Gather information related to the application and eligibility determination for an individual, including resource information and third party liability information, as a prelude to submitting a formal Medicaid application.
  11. Assist individuals with acquiring forms and compiling required documentation, provide technical assistance, coordinate with eligibility determination professionals, and perform all other duties related to completing and submitting a Medicaid application.
  12. Assist the individual in collecting and gathering required information and documentation for the Medicaid application.  This assistance may be provided in the individual’s home.  The activity includes assisting the potential applicant, as a secondary resource to family members and care providers, in gathering information and completing an application for Medicaid benefits.
  13. Refer the individual to the local (or ADRC collocated) DCF/ACCESS staff to make application for Medicaid benefits.  Coordinate with these staff regarding eligibility matters for Medicaid eligible or potentially eligible individuals.
  14. Assist in obtaining the Physician Referral Form (3008) for Medicaid Waiver probable individuals and coordinate with CARES staff for determination of functional eligibility.
  15. Collect, review and maintain accurate Medicaid eligibility determination tracking data to ensure completeness, accuracy and timeliness.
  16. Track Medicaid applications through the eligibility process.
  17. Contact individuals on the APCL as required to update information and screen for Medicaid eligibility.
  18. Participate in meetings with DCF, CARES and other entities as appropriate to facilitate and enhance Medicaid eligibility determination process.
  19. Act as a consumer advocate by coordinating with CARES and DCF/ACCESS staff to resolve in a timely manner any eligibility issues that arise during the Medicaid eligibility determination process.
  20. Standardize and make consistent outreach efforts to ensure public awareness of Medicaid programs and services and how to access them.
  21. Develop, compile and distribute materials to inform individuals about the Medicaid programs as well as how and where to obtain those benefits.  Note: This activity does not include compiling information already available through the Medicaid agency or Department of Elder Affairs.
  22. Build relationships with and educate service providers, professional entities and other professionals, such as hospital discharge planners and nursing home social workers, to facilitate referrals and increase awareness of Medicaid resources.
  23. Regularly meet with and train ADRC Access Points to increase awareness of Medicaid resources to individuals and target populations.
  24. Perform other Medicaid-related duties as assigned, which may include counseling disaster victims about Medicaid programs, options and eligibility process.

EDUCATION and/or EXPERIENCE

 

  1. Have a Bachelor’s Degree from an accredited college or university in a human services related field; or
  2. Have an Associate of Arts Degree from an accredited entity in a human services related field and a minimum of two years’ experience as a caseworker, case manager, intake specialist, or related work experience with the long-term care client population; or
  3. Have a high school diploma or GED and four years’ experience as a caseworker, case manager, intake specialist, or related work experience with the long-term care client population

ESSENTIAL DUTIES AND RESPONSIBILITIES-MEDICAID WAIVER SPECIALIST

This professional staff is 100 percent (100%) Medicaid related and shall have the following training, experience, knowledge, and skill set in addition to the ability to perform the duties described for Medicaid Administrative Claiming Staff:

  1. Knowledge of computer applications to perform the functions of the position, including work processing, database, and spreadsheet applications;
  2. Knowledge of and the ability to navigate CIRTS, FMMIS, DCF’s Florida System;
  3. Experience in training, including public speaking and developing training materials and the provision of training and ongoing technical assistance; and
  4. The ability to work independently and with minimal supervision.

Qualifications:

  1. Possess a Bachelor’s Degree in social work, sociology, psychology, gerontology, or related social services field, plus one year of related work experience; or
  2. Possess a Bachelor’s Degree in another field of study no related to social services, and two years of related work experience.  (Professional human services experience may substitute for a Bachelor’s degree on a year-for-year basis.).

LANGUAGE SKILLS

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

 

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: 

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

COMPUTER SKILLS 

Proficient in computer  applications with the ability to utilize a computerized resource data base and match clients’ needs and resources.

 

CERTIFICATES, LICENSES, REGISTRATIONS

Eligible to become certified as an Information and Referral Specialist.  Must successfully complete DOEA Client Assessment Training with passing score.

 

SUPERVISORY RESPONSIBILITIES:

None

PHYSICAL DEMANDS: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the activities are required of the employee:

The employee must occasionally lift and/or move up to 10 pounds.  No special vision requirement.

 

WORK ENVIRONMENT: 

 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the environment is usually moderate.