Medicaid LTC Financial Eligibility Case Reviewer (100% Remote)

Overview

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. Duties and Deliverables Key responsibilities include, but are not limited to 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 Knowledge, Skills, and Certifications Successful candidates will demonstrate 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. Familiarity with Federal and New Hampshire Medicaid financial eligibility regulations and processes preferred.

Minimum Qualifications

High school diploma, or equivalent required. Must be 18 years of age or older. Some college training preferred. 1-3 years of experience performing reviews for public programs with eligibility requirements; experience with Medicaid or Medicaid LTC eligibility preferred. 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. Location & Schedule This is a fully remote, hourly position with set working hours during New Hampshire state business hours, Monday through Friday, from 800 AM – 400 PM ET. Incumbents must have private space and adequate Wi-Fi connectivity during all working hours Compensation and Benefits The hourly rate for this position is $23.00 per hour. At SSO, we invest in our people—supporting your health, financial security, and growth. Benefits include Health, vision, and dental insurance 401(k) with discretionary employer match Paid time off and holidays Flexible spending accounts Other Perks Apply To this Job