Staffing Solutions Organization LLC (SSO) , an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
Medicaid LTC Financial Eligibility Case Reviewer (100% Remote)
Overview:
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.
Duties and Deliverables:
Key responsibilities include, but are not limited to:
- 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.
- Maintain accurate and timely documentation of applicant information using State case management and eligibility systems
- Review assigned cases for completion and identify whether additional documentation or information is needed to make eligibility determinations or redeterminations.
- Schedule and conduct virtual interviews with applicants to review and confirm application documentation and information.
- Provide education to applicants and their representatives around financial eligibility criteria and any additional documentation required.
- Use provided checklists, tools, and decision trees to verify whether documentation demonstrates applicants meet State and Federal financial eligibility criteria.
- Utilize State case management systems, checklists, and verification tools to develop and submit eligibility recommendations in accordance with State policy and federal Medicaid rules.
- Receive and process calls and electronic inquiries (email, phone, fax) related to application status, documentation questions, timelines, and next steps.
- Support supervisor with correcting errors identified during quality assurance audits
Knowledge, Skills, and Certifications:
Successful candidates will demonstrate:
- Ability to work independently and collaboratively in a remote team environment.
- Ability to gain in depth understanding of New Hampshire Medicaid long-term care financial eligibility criteria and apply these principles to applications.
- 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.
- Ability to explain processes, documentation require