
Dynamic Entitlement Specialist at Elderserve Health Plan with a proven track record in ensuring Medicaid eligibility through expert problem-solving and meticulous documentation management. Skilled in conducting comprehensive application reviews and client interviews, I excel in resolving complex issues while fostering strong customer relations to enhance member satisfaction.
Medicaid Maintenance & Renewals: Ensures continuous Medicaid eligibility for members by managing and submitting timely Medicaid recertifications (90-60 days prior to expiration).
Application Assistance: Completes new
Medicaid applications and RVI-3 (Resource
Verification Indicator) conversions.
Documentation & Record Keeping: Assists
members in gathering required financial and personal documentation and maintains
comprehensive records of all submitted
applications and renewals.
Field Visits & Outreach: Conducts in-home
visits to members to assist with the gathering of documents and to guide them through the renewal process
Issue Resolution: Acts as the primary point
of contact for resolving complex, problematic Medicaid issues, including working with the Office of Homecare Services to address denied claims.
Application Review and Processing:
Conduct comprehensive reviews of Medicaid applications, including financial records income, assets, and documentation to determine eligibility for coverage.
Client Interviews and Guidance: Interview
applicants or authorized representatives to
gather necessary information, explain
coverage options, and assist with the application process.