Medical Coordinator

Pay Range: $31.34 to $36.16/hour

JOB CULTURE

The Masons of California are committed to a culture of leadership.  Our culture is to provide superior service to the members, residents, and staff through a sound and progressive model of service/care which aligns our mission, vision, and operations.  We demonstrate excellence in core service and understand the true value of time, budgets, safety, and satisfaction.  We are dedicated to disciplined innovation while creating a culture of continuous quality improvement - we are a learning company.  We are committed to sharing our knowledge and being an organization that naturally attracts the best and brightest talent.  We are can able to perform both essential functions and measurable behaviors while being team-oriented, caring and honest.

JOB SUMMARY

Facilitate the processing of Medical applications and renewals working closely with the Social Services Department.  Reports to Revenue Manager.  Research for any opportunity to increase revenue from eligible medical benefits.

ESSENTIAL FUNCTIONS

• Facilitate MediCal applications, redeterminations, and MediCal County transfers, and renewals working closely with the Social Services Department. Create a database/working file to monitor residents for MediCal applications and renewals.
• Complete 100% of required MediCal redeterminations and County transfers within designated deadlines.
• Maintain and update resident MediCal status database with 100% accuracy on a rolling basis.
• TAR preparation and submission.  Ensure all the required information and supporting documentation are completed.
• Submit TARs within 24–48 hours of receiving all necessary documentation.
• Ensure 100% compliance with required supporting documentation.
• Stay current with regulatory changes and research opportunities for additional revenue from medical benefits.
• Conduct regulatory updates review monthly and provide summaries to leadership.
• Ensure Medicare/Insurance eligibility for Short-Term Medicare/HMO residents upon admission.
• Verify Medicare/HMO eligibility for 100% of short-term residents within 24–48 hours of admission.
• Maintain accurate insurance records with a 100% compliance rate for audits.
• Ensure MediCal eligibility for Long-Term residents monthly.
• Conduct eligibility checks for 100% of long-term residents monthly and resolve issues within 5 business days.
• Stay informed with regulatory changes and share/train other employees when appropriate.
• Provide training or informational updates on MediCal application changes at least once per quarter to relevant staff.
• Serve as a liaison between Accounting and Health Care Departments
• Respond to inquiries from Accounting and Health Care Departments within 24–48 hours.
• Ensure smooth communication and problem resolution with minimal rework required.
• Assist during MediCal audit.
• Ensure all required audit documentation is prepared and submitted by audit deadlines.
• Maintain zero major compliance findings due to incomplete or incorrect information.
• Adhere to and complies with security, safety, and health standards in the workplace.
• Perform other duties as requested or required.
• Complete ad-hoc requests within agreed-upon timelines while maintaining core productivity levels.

SKILLS, ABILITIES AND EXPERIENCE

• Advance in Microsoft Excel (Vlookup,Xlookup,IFs), use of word processing (Microsoft Word)
• Minimum two years of medical billing, cost reimbursement or third-party payment experience, preferably with some exposure to other accounting related functions, including A/R, A/P, and G/L.
• Computer skills including spreadsheet preparation, CMS database navigation and HealthCare software programs like MatrixCare.
• Strong mathematical and analytical skills.
• Experience with third-party medical providers contracts required.
• Excellent communication and inter-personal skills.
• Ability to handle multiple tasks, set priorities and meet deadlines.
• Must be extremely well-organized and detail oriented.

Requirements

EDUCATIONAL REQUIREMENTS/LICENSES/CERTIFICATES
Any combination of education and experience that would provide the necessary knowledge and abilities listed, typically:

• AA degree in accounting or business, or equivalent and at least two years of experience in medical-related billing

Benefits

At Grand Lodge, we are looking for team members who would like to combine their passion for helping people, good communication skills, decision-making skills, and great ethical standards with the opportunities to advance your career.

In return for your skills, you will be offered:

• A work environment focused on teamwork and support
• Excellent health, wage replacement and other benefits for you and your family’s well-being
• A generous contribution to a 401K plan whether or not you participate, and an additional contribution from the company when you participate in the plan
• Investment in your growth through Tuition Reimbursement
• Paid time off