Eligibility Specialist/QIDP

BCFS

Job Description


Critical Action Items:

  1. Monitor resident's insurance and Medicaid eligibility ongoing basis.
  2. Meet Face to Face with guardians to review Medicaid eligibility and insure applications submitted on time with no lapse in coverage
  3. Track Medicaid renewal dates and update case files including Therap
  4. Acquire private insurance annual denial letters and submit to Medicaid as identified for each resident affected
  5. Update Therap with all insurance information
  6. Meet with resident's guardians and complete and submit annual and as needed Medicaid eligibility documents to include:
    1. Medical Power of Attorney
    2. Hospital Selection
    3. Do Not Resuscitate Form
  7. Monitor and track guardianship papers and file electronically and hard copy in case file
  8. Update Emergency Contact Data regarding guardianship in electronic and hard copy and update QIDP, House Managers and Medical Staff
  9. Update case file both hard copy and electronic of all DNR and hospital preferences
  10. Meet with guardians to verify resident meets all eligibility for services at BVT
  11. Update QIDP, Biller, Program Director and Medical Staff of any and all changes in eligibility
  12. Update Trust Fund expenditures and requests by residents and guardians
  13. Maintain Trust Fund accuracy and provide information as requested and required to DADS Trust Fund auditor
  14. Update guardian when trust fund balance has less than one month of PNA funds available to resident.
  15. Monitor and track annual IDRC due dates and coordinate completion with QIDP with minimum of 2 weeks prior to expiration.
  16. Enter IDRC information into TMHP website as service authorization and monitor.
  17. Assist Program Director with review of Absences and entry into TMHP/CARE all movement
  18. Assist Program Director with completion of Living Options prior to expiration/past due status in CARE system
  19. Perform the various duties required of a QIDP (Qualified Intellectual Disabilities Professional) including developing, monitoring and revising active treatment goals and objectives; conducting annual Interdisciplinary Team Meetings (IDT) and interim IDT meetings for residents; writing quarterly, interim, and annual reports for residents as assigned.
  20. Observe and document resident behaviors on appropriate forms such as Behavior Progress Notes, Weekly Progress Notes, or other forms as necessary.
  21. Maintain awareness of resident rights restrictions, prepare documents for rights restrictions and participate in the Human Rights Committee as needed and maintain appropriate documentation.
  22. Maintain awareness of individuals without guardians who are unable to make an informed decision, completing and submitting documentation to a Surrogate Decision Making Committee as needed and appropriate.
  23. Assist each resident toward the achievement of active treatment goals, working both formally and informally to provide active treatment through all activities and interactions.
  24. Provide transportation for residents to appointments and activities or with shopping needs and personal errands as needed.
  25. Assist Program Director in filing and completing various monthly documents and documentation.
  26. Coordinate with parents and guardians and House Managers any Day Hab absences for each assigned resident and update and coordinate services with Day Hab and Program Director of all schedule
  27. Attend all meetings as assigned by Director of Residential Services

Measurable Deliverables:

  1. Trust Fund balances monthly with accounting
  2. Annual Medical eligibility forms updated and reviewed including DNR, Hospital Preference and Medical Power of Attorney completed prior to 1 year
  3. Monthly report to Program Director on status of each case and pending action for next 30 days
  4. Meet with guardians to review annual eligibility requirements in timely manner.
  5. Document resident behaviors on appropriate forms.

Other Responsibilities:

  1. Perform other job duties as assigned by Director of ICF-IID Services.
  2. Attend Psychological appointments if RN is unable to attend.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job Requirements

Education:

Bachelor's Degree in Human Service Field.

Experience:

Experience working with individuals with intellectual and developmental disabilities or some other form of direct care. Prefer individual certified as a QIDP and experience with completing, submitting, and monitoring Medicaid applications. Must be competent and proficient working with Microsoft Word, Excel and Outlook.

Requirements:

  1. Possess a valid driver's license, work eligibility status and have a good driving record.
  2. Must pass all background checks including: Criminal, Employee Misconduct, Nurse's Aide Registry, Driving check.
  3. Able to organize and prioritize a wide variety of tasks
  4. Able to work in a team environment with flexibility.
  5. Know the indicators of abuse, neglect, and exploitation and the appropriate documentation and reporting procedures.
  6. Able to complete Medicaid application and meet effectively and supportively with guardians.
  7. Know procedures for administering, charting, and storing resident medications.
  8. Communicate promptly with Director of ICF-IID, QIDP, and /or biller regarding needs and problems of individual ICF-IID residents.

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