(Internal Only)Medicaid Specialist - $27,238.00 - $39,847.00 Annually

Medicaid Specialist

Job Code: MS - 107
Revision Date: Dec 21, 2018

Salary Range:  
$13.10 - $21.42 Hourly
$1,048.00 - $1,713.60 Biweekly
$27,238.00 - $44,558.00 Annually

FLSA: Non-Exempt


We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

The purpose of this job is to performs administrative/clerical duties for the Benefits Assistance Program to include local travel to outpatient clinics on a regular basis.  Assists consumers with chronic mental illness and/or IDD in obtaining Social Security Disability Benefits through clear, effective and efficient Medicaid Policy, Programs and Billing. This job involves fact checking, record keeping and advocacy on behalf of their clients.  It follows established policies & procedures.  Places priorities in assisting consumers obtain Supplemental Security Income/Medicaid.

This class works under close supervision according to set procedures.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

  • Obtains medical records from the Outpatient Clinics and submit to Social Security Administration, DDS or ODAR.
  • Provides client services, including support for families, in a wide variety of fields, such as psychology, rehabilitation and social work.
  • Requests necessary information to determine eligibility in an accurate and timely manner.
  • Processes initial claims for the clients at their assigned units.
  • Ensures all state requirements are met, as well as securing all required documentation.
  • Completes correspondence for consumer's medical requests (SSA correspondence, etc.).
  • Processes Medicaid claims through the Community Partnership with HHSC.
  • Enrolls clients requesting the Affordable Healthcare Insurance.
  • Assists assigned clients in completing the ADL's and Work History Reports within 2 weeks of receipt.
  • Confirms the Consultative Exams their assigned clients have pending and report to DDS that the clients will attend to the consultative examination.
  • Transfers claims upon denial to a Senior Disability Claim Team member assigned per clinic. 
  • Maintains confidentiality of all business matters.
  • Processes monthly reports for the consumers served.
  • Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires an Associate's Degree in Behavioral Sciences supplemented by one (1) year of experience working with claims processing, insurance, office administration or related field; or equivalent combination of education, training, and experience which provides the required knowledge, skills, and abilities.

Experience with trauma-informed services; cognitive behavioral therapies, including DBT; and motivational therapies including the use of incentives, preferred.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principals, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

  • None

Special Certifications and License

  • Must possess and maintain a valid state Driver's License with an acceptable driving record.
  • Must be able to pass a TB, criminal background and drug screen.

Americans with Disabilities Act Compliance

Emergence Health Network is an Equal Opportunity Employer.  ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

  • Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
  • Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally-competent and recovery-oriented care.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.