About the position
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.
Responsibilities
• 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
Requirements
• 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 requirements, and complex eligibility rules to applicants with a diverse range of communication and functional skills.
• Competency in applying quality customer service principles
• Strong organizational, documentation, and problem-solving skills.
• Excellent communication and interpersonal skills, with sensitivity to diverse populations.
• High school diploma, or equivalent required.
• Must be 18 years of age or older.
• 1-3 years of experience performing reviews for public programs with eligibility requirements.
• Ability to speak, read, and write English clearly and concisely.
• Employment is contingent on completion of a background check.
• Must have a private space with no distractions and reliable, high speed internet connection.
Nice-to-haves
• Familiarity with Federal and New Hampshire Medicaid financial eligibility regulations and processes preferred.
• Some college training preferred.
• experience with Medicaid or Medicaid LTC eligibility preferred.
Benefits
• Health, vision, and dental insurance
• 401(k) with discretionary employer match
• Paid time off and holidays
• Flexible spending accounts
• Other Perks