Job Description
Job Location: CNSWFL Forum - Fort Myers, FL 33905Education
Level: High School
Salary Range: $20.41 Hourly
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- - - Child Medicaid cOORDINATOR
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- - - Florida
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- - - Children’s Network of Southwest Florida, LLC
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- - - Revenue Maximization Supervisor
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- - - FLSA Status
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- - - Statement
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- - - This job description will be reviewed periodically as duties and responsibilities change with business necessity. Essential and marginal job functions are subject to modification.
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Mission Statement
The Children’s Network of Southwest Florida is committed to working with the community to protect children and preserve families.
General Purpose of Job
This is supervised office-based work in the Children’s Network of SWFL’s Revenue Maximization unit requiring a working knowledge of Medicaid managed care plan enrollment and benefits. Tasks for this position include timely enrollment onto the appropriate Medicaid managed care plan for children entering the child welfare system, assisting with Primary Care Physician (PCP) changes, dental and medical plan changes and processing incoming Medicaid mail. These responsibilities require professional interaction with case managers, caregivers, medical and dental offices, Medicaid plan staff, and other stakeholders providing exceptional customer service, support and assistance. The Child Medicaid Coordinator must acquire the skills to become proficient with several statewide management information systems including FSFN, FLORIDA, and FLMMIS and must gain familiarity of the Florida child welfare system.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/ or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Duties and Responsibilities
- Assist case managers, foster parents, caregivers and doctors’ offices with Medicaid questions or issues of access to Medicaid services.
- Provide timely and thorough review of all mail from AHCA ensuring all notices are responded to appropriately to avoid any lapse in coverage. If a lapse in coverage does occur, work with the Rev Max Specialist to reinstate benefits promptly and assist case manager or caregiver as requested to ensure the child continues to receive services as needed.
- Review and maintain all Medicaid and medical related correspondence. Review medical bills and research coverage before forwarding to Utilization Management Unit.
- Coordinate distribution of all member ID cards, handbook or other notifications to case managers as received by the Lead Agency.
- Complete necessary Primary Care Physician (PCP) changes to ensure children receive appropriate medical care. Communicate with medical offices to coordinate timely appointments, as necessary.
- The Child Medicaid Coordinator will make a health care plan selection within the month the notification that a selection (Choice) can be made.
- The Child Medicaid Coordinator will utilize the Evolve client portal, FLMMIS, and FLORIDA system to access necessary information and review account information.
- Provide education on the benefits and expanded benefits of the child welfare specialist plan.
- Maintain relationships with insurance company representatives and provide necessary documents for change requests.
- Assist in Scanning of appropriated documents including Member Identification Health Plan Card
- Training: Attends and successfully completes all mandated training courses within the probationary period, and as scheduled thereafter.
- Other duties may be assigned as special projects may be requested.
Working HOurs
CNSWFL’s work week is Monday through Friday, 40 hours per week. Your supervisor will advise you of your work hours; however, business office hours are 8:00 am to 5:00 pm.
Travel
Travel in and outside of Circuit 20 (Lee, Charlotte, Collier and Hendry/Glades counties) is required.
Training
All employees must complete fifteen (15) hours of on-line or classroom Training on an annual basis. If the employee is a Certified Child Welfare Professional, Training hours must total twenty (20) annually.
Supervisory Responsibilities
This position has no supervisory responsibilities
Education and Experience
High School diploma or equivalent and at least 2 years of related work experience; or Associate’s Degree from an accredited college, university, or technical school and 1 yr. related experience. Official transcripts are a mandatory requirement Prefer experience working with Medicaid health plans. Medical office or pharmacy experience a plus.
Skills and Abilities
Must be able to operate standard modern office machinery, including fax, telephone, calculator, computer, scanner, printer, copier, and mail machine. Minimum typing speed of 45 wpm; excellent word processing skills. Must be competent with Microsoft Office Suite programs, including Word, Excel, and Outlook. Must be competent with basic e-mail protocol and procedures including sending, receiving, replying, attachments, and meeting scheduling. Must possess excellent organizational skills and abide by the highest standards of confidentiality. Must communicate effectively and have excellent customer service skills.
pre-employment requirements
Certificates, License, Registrations, backgrounds, drug screens, Etc.
- Valid driver’s license required, with a clean driver’s license check, and proof of insurance
- Driver’s license check is a requirement
- No special certification or registration is required for this position
- Criminal background screening (fingerprinting) (Local Law Enforcement and FBI/FDLE), and Abuse Registry Check
- Drug Screening is a requirement
- Children’s Network participates in E-Verify
Other Requirements
Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions, common inquiries, or complaints from groups of managers, clients, customers, and the public. Ability to speak effectively before groups of customers or employees.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, percentages, ability to draw and interpret bar graphs.
Reasoning Ability
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to be proactive, as well as handle problems involving several concrete variables in standardized situations. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
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.
This job requires the ability to sit for extended periods; walk; stand; use hands to finger, handle or feel; reach with hands and arms; stoop, kneel or crouch; talk and hear. This job requires visual acuity sufficient to read and operate standard modern office machines. The employee must occasionally lift and/or move up to 25 pounds.
This job requires normal or corrected normal vision for reading documents and computer screens.
WORK ENVIRONMENT
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.
This is administrative work in an indoor office environment with a moderate noise level (business machines, printers, computers, telephones).
ADA: Children’s Network of Southwest Florida, LLC will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990.
EEO: Children’s Network of Southwest Florida, LLC does not discriminate based on race, national origin, gender, religion, veteran status, or disability in employment, in provision of services, or in access to programs.
Children’s Network of Southwest Florida, LLC is a Drug-Free Workplace.
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- - - All personnel must demonstrate the following capacities:
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- - - - A commitment to empowering others to solve their own problems
- - - - Valuing a nurturing family as the ideal environment for a person
- - - - A conviction about the capacity of people to grow and change
- - - - The ability to establish a respectful relationship with persons served to help them gain skills and confidence
- - - - The ability to work collaboratively with other personnel and/or service providers or professionals
- - - - The capacity to maintain a helping role and to intervene appropriately to meet service goals
- - - - The ability to set appropriate limits
- - - - Safety and permanency of children
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I certify that the statements above to the best of my knowledge accurately describe the duties performed and agree that I am qualified in education and skill to meet the requirements of the position. If the employee does not agree, indicate here:
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Qualifications
- High School diploma or equivalent and at least 2 years of related work experience; or Associate’s Degree from an accredited college, university, or technical school and 1 yr. related experience.
- - Official transcripts are a mandatory requirement
- Prefer experience working with Medicaid health plans.
- Medical office or pharmacy experience a plus.
Must pass a Level II Background Check. For more information please click this link: https://info.flclearinghouse.com
Remember: If you are currently an employee of Children’s Network of Southwest Florida, LLC, or one of our Case Management Organizations, it is necessary that you notify your current Supervisor, prior to applying.
