Entitlement Coordinator- Managed Care
Archcare Managed Care Organization - Brooklyn, NY

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Monitor the track and submission of Medicaid Pending cases to assure that resident representative is filing timely with county, then follows up until Medicaid approvals are obtained. Monitors yearly recertification of Medicaid and ensures timely completion of Medicaid recertifications. Monitors Medicaid surpluses and tracks payments. Assist participants in obtaining entitlement benefits.



Confirms Medicaid eligibility


Maintain log of Medicaid Pending participants and provides follow up and reporting on Medicaid pending cases.


Confirms that once application is submitted PACE receives receipt and notice of decision within regulatory time frames.


Contacts participant and or responsible party to confirm and review documentation needed for Medicaid application. Follow up with county that all pertinent documents was submitted. Continue to follow up until Medicare Medicaid decision is obtained.


Track and supply facility with Medicaid approval discrepancies of NAMI amounts and pick up dates until corrected by county.


Assures that Medicaid and Medicare are notified of participant''s enrollment in PACE


Monitors Medicaid and Medicare status of each participant on an on-going basis.


Oversees and supervises Entitlement Coordinator


Assures that Entitlement Coordinators work load is acceptable, submits work in a timely manner, provides appropriate follow up, monitors Medicaid and Medicare status.


Provides social work to a case load of participants as needed for program operations


Manages entitlement department; establishes policies, procedures, standards and objectives for department operation; evaluates performance of entitlement staff, maintains quality assurance; coordinates with other department to provide maximum level of services.


Perform all other duties, as assigned


Formal Education : Bachelor's Degree

Experience : 5 years

License, Registration, and / or Certification Requirement : No

Minimum Knowledge : Requires ability to interpret/extract information and/or perform arithmetic functions.

Language Ability : Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Experience Requirements

Minimum of 5 years Medicare/Medicaid eligibility experience.

Have 1 year of experience with a frail or elderly population

Skill Requirements

Excellent oral and written communication skills with all levels of management.

ArchCare - 15 months ago - save job - block
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