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Job Description

The Facility Financial Specialist is responsible for welcoming and directing new residents and their families on the day of admission. He/she is responsible to meet with each new admission and/or the designated responsible party in order to complete all financial documents, explain billing procedures, and supervise the Medicaid process to ensure that the resident and/or responsible party fully understand their financial obligations to the facility.

ESSENTIAL POSITION FUNCTIONS:

ADMINISTRATIVE / TECHNICAL

+ Will provide tours of the facility to prospective residents and interested parties. Responsible for greeting the newly-admitted resident and their family upon arrival and will accompany them to the assigned room. Introduce resident/family to staff members.

+ Will conduct a post-admission meeting with the resident and/or responsible party (preferably on the day of admission) to complete the following objectives:

+ Reviews the Admission Agreement with the resident and/or responsible party and obtains the appropriate signatures.

+ Reviews information obtained from the Admissions staff on the day of admission including the application for admission, pre-admission notes and face sheet, and the primary insurance coverage (other than Medicare). Verifies the Medicare benefit and coverage as well as benefits and coverage for all secondary insurances. (Admissions will obtain pre-authorization for primary insurances other than Medicare). Obtains copies of the resident’s insurance cards, POA or guardianship forms, and reviews the potential coverage with the resident and/or responsible party. Will give an explanation of co-pays due and collect co-pays if applicable and complete the Estimated Insurance Coverage sheet and obtain acknowledgements.

+ .Explain the resident trust fund as well as all services available with fees involved – cable television, telephone, beauty shop services, etc. Will collect payment for phone and cable hook ups and arrange for services. Will complete paperwork to begin a resident trust fund if requested and collect deposit for such fund. Will serve as coverage when the resident trust fund employee is not working.

+ Will complete the Medicare Secondary Questionaire with the resident and/or responsible party.

+ Will assess when/if Medicaid assistance is needed. Explain the Medicaid process and provide a Medicaid application packet to the resident/responsible party with instructions and a time frame for completion. Will obtain signature to complete addendum II and will collect full financial disclosure form – addendum III. If only a partial review is needed, will explain what documents are required to fully open the long term coverage and will follow up with the resident and /or responsible party until the items are obtained. Will establish a secure file to hold the information collected until Medicaid requests submission. If a full Medicaid application is required, will assess the resident or responsible party’s ability to complete the process per the established protocol. Will provide supervision and guidance until the process is completed and the case is opened. In cases, where there is no one available or able to assist the resident and the situation falls within the established protocol, will complete the Medicaid process for the resident including completion of the application, collection of needed documents, and a personal appointment with Medicaid if needed. For private pay situations, will collect the company fee for this service. Will keep a standardized spread sheet of all cases in progress.

+ Will estimate the expected NAMI (Net Available Monthly Income) amount required by Medicaid and explain payment procedures to the resident/responsible party particularly as to when NAMI is due. Will explain the direct deposit system and obtain signatures to open the direct deposit account for long term residents.

+ Will maintain a caseload of all Medicaid pending cases and will follow cases until the determination for coverage has been made or the payment plan is in place. For any denied cases, will obtain reason for denial and follow up with the resident and/or responsible party to obtain the needed documents within the time frames allowed. Will report denials to the Administrator and business office staff so that collection can begin. Will meet routinely with the Administrator and business office staff to give updates on Medicaid pending cases or complex financial situations.

+ Will distribute copies of all forms generated by the Facility Financial Specialist to the assigned social worker and business office. Will facilitate the completion of POA if needed and will become a notary if requested.

+ Will be available to residents and/or responsible parties to explain the Nursing Home bill if needed and will accept payments.

+ After receiving an update from the business office and pharmacy, will meet with the resident and/or responsible party prior to discharge to collect additional payment for services provided during the stay and to review the status of coverage for the stay and any bills still pending with insurances.

+ Will meet with long term residents to review the liability insurance video and complete addendums I, II, and III if not previously completed.

COMMUNICATION

+ Acts as liaison for facility relations with the general public. Demonstrates a customer-oriented philosophy reflecting the core values of Heritage Ministries and conveys this to staff and residents.

+ Interacts courteously with all residents, family and general public. Promptly reports all complaints and concerns to their Supervisor.

+ Utilizes e-mail and computer system to maximize communications, productivity and efficiency between departments, staff, and supervisors.

+ Maintains strict confidentiality of information as it relates to resident’s personal matters and facility business.

+ Follows appropriate chain of command within department and facility organizational structure.

+ Attends all required facility in-service programs and other various facility and department meetings, seminars, and conferences as directed.

Benefits:

+ Paid time off (on an accrual basis

+ Paid sick time (New York)

+ 401k

+ Employer contributed Medical, Dental, and vision insurance

+ Employer paid life insurance

+ Paid training opportunities

+ Education Assistance plans

+ Employee pharmacy program

+ Special employee recognition and giveaways

CONTINUOUS QUALITY IMPROVEMENT/SAFETY

+ Ensures clerical responsibilities of the Facility Financial Specialist’s office are consistent with philosophies and objectives of the facility administration.

+ Ensures accuracy of documentation, record information and compliance with facility policies and procedures and Department of Health regulations.

+ Maintains a neat, clean and orderly work environment. Assists in monitoring facility for resident and co-worker safety. Informs Administrator of any safety issues. May participate in a Safety Committee.

+ Is knowledgeable and responds to nursing and building emergencies according to established policy and procedure.

+ Actively contributes to Continuous Quality Improvement program as evidenced by attendance to, in-services, and participation in applicable auditing and committees.

+ Enhances own professional growth and development through participating in educational programs, in-service meetings and workshops, and reading of current literature.

+ Observes and follows all safety rules and regulations. Observes and reports safety hazards in a timely manner. Uses facility provided safety equipment as required.

+ Supports and enforces infection control policies and procedures when needed. Follows policy and procedure regarding universal precautions, isolation, glove use, linen precautions, hand washing and other specialized nursing procedures to prevent the spread of infection.

+ Complies with OSHA regulations and guidelines while on duty.

GENERAL

+ Supports and adheres to Heritage Ministries Mission Statement and Philosophy of Care.

+ Demonstrates a cooperative, courteous and respectful image at all times while on duty or representing Heritage Ministries. Supports staff by assisting co-workers with a teamwork attitude.

+ Observes and promotes residents’ rights at all times.

+ Adheres to work schedule by regular and punctual attendance.

+ Observes and adheres to departmental and position control dress code guidelines.

+ This job description is not intended to be all-inclusive. The Facility Financial Specialist will perform other duties as assigned.

Requirements

SUMMARY OF QUALIFICATIONS: Able to perform each of the essential position functions.

+ High School Diploma or GED/TASC required. Preferred Bachelor’s Degree, Associate of Arts Degree, or course work from an accredited college or university in a human services related field.

+ Preferred experience as a caseworker, case manager, intake specialist, or related work experience with the long-term care client population, preferably Medicaid related experience.

+ Strong knowledge of Medicaid guidelines and statutes, and working knowledge of long term care billing process preferred.

+ Demonstrated understanding and experience with computer application, typing, filing, and general office procedures.

+ Accuracy and attention to detail required.

+ An effective ability to read, write, and speak the English language is required.

+ Ability to interact appropriately and professionally with staff, residents, vendors, volunteers, and the public in person and via the telephone.

+ Ability to prioritize and coordinate tasks and assignments while working with little or no supervision at times.

+ Must be able to meet health assessment requirements, including required testing and health documentation.

+ Ability to stand, sit, walk, bend, stoop, squat, twist and engage in repetitive motion for extended periods of time.

+ Ability to meet deadlines and handle stressful situations.

This organization reserves the right to revise the essential position functions and responsibilities as the need arises.