POSITION SUMMARY

The Social Services Coordinator will apply working knowledge of the Florida Medicaid regulations and Social Security Administration to an assigned caseload in order to obtain and maximize, Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiary (SLMB), Qualify Individual (QI1), and Low-Income Subsidy (LIS).

Position is fully onsite, from Monday-Friday.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Conduct telephonic and mail outreach materials to members and prospects.
Assist members to complete application for state and federal Medicaid Programs.
Identify and pre-screen prospective members for the QMB, SLMB, QI1, and LIS.
Interview with clients and families and coordinates and plans for programs and activities to meet their social and/or emotional needs.
Comply with government regulations in all areas of responsibility required, i.e. signatures on all forms for Medicaid and LIS.
Follow up with the Department of Children and Families and Social Security Administration on Medicaid and LIS applications in a timely manner.
Prioritize daily duties and adapt quickly to changing responsibilities.
Maintain updated knowledge of existing and new regulations on Medicaid and Social Security.
Assist members as well as prospects in person or on the telephone with questions or concerns.
Maintain accurate and organized inventory of cases.
Able to work with other departments such as Sale, Case Management and Member Services.
Adheres and ensures compliance with Risk Management Program policies and adverse incident reporting.
Understands and interprets policies and procedures.
Ensures the compliance of CMS/AHCA rules and regulations that are being observed, as well as the HIPAA regulations as applied to PHI.

Other duties as assigned.

QUALIFICATIONS AND EDUCATION

High School Diploma or equivalent combination of training and experience.
Understanding the Social Service goals and objectives in the managed care environment
Knowledge of computer software packages and operations, especially Word, Excel, and Outlook.
Able to communicate effectively in oral and written forms with internal staff, members, families, and providers.
Ability to work within set deadlines.
Professional, high degree of accuracy, detail oriented, confident and flexible.

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.
Fast-paced office environment.
Highly regulated environment.
Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and move intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or listen. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

Duties accomplished at the end of the day/month.
Attendance/punctuality.
Compliance with Company regulations.
Safety and Security.
Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.

Employee Acknowledgement:

I have read this job description and understand what is expected of me while I occupy this role.

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