Job Description
Job Description
The Elderly Waiver (EW) Specialist is responsible for ensuring accurate, timely, and compliant reimbursement for residents receiving services through Minnesota waivers, primarily EW and CADI. This includes monitoring renewal deadlines, ensuring complete and timely submission of renewal applications, coordinating assessments, completing 6790s, and working closely with residents, families, and county agencies.
Key Responsibilities
- Manages reimbursement for services provided to residents utilizing EW/CADI in assisted living settings, in collaboration with Billing Specialist, Clinical, Operations and Admissions.
- Confirms eligibility prior to admission – MN-ITS verifications
- Completes 6790/Customized Living tools utilizing clinical documentation as well as face to face interactions. Ensures documentation supports authorized services.
- Direct communication with clinical in each community to be updated on changes to services and leave of absences
- Monitor support plans, service authorizations, rate changes, and renewals
- Audit EMR to ensure changes of conditions are being accurately reported and updated 6790 submitted as appropriate
- Educate clinical and administrative staff on documentation best practices impacting reimbursement
- Identify reimbursement risks and proactively recommend corrective actions
- Stay current with Minnesota DHS waiver policies, rate frameworks, and regulatory changes
- Track and monitor all MA renewal dates and application timelines.
- Ensure renewal forms and documentation are completed accurately and submitted in a timely manner, at least 30 days prior to renewal date.
- Follow up on submitted applications to ensure approval and resolve any issues that arise.
- Assist residents and families in understanding and navigating the transition from private pay to Medical Assistance.
- Provide support in gathering required documentation and completing necessary paperwork.
- Maintain clear and compassionate communication throughout the process.
- Schedule and coordinate county assessments when required for MA eligibility or reassessments.
- Build and maintain strong working relationships with county case workers to facilitate communication and issue resolution.
- Work closely with the EW Biller to ensure accurate information sharing and a seamless resident transition.
- Participate in internal team meetings as necessary to review status of residents on or transitioning to MA.
- Work with facility Executive Directors, to complete and gather necessary documents.
- Maintain detailed records of application and renewal status, communication with counties, and documentation submitted.
- Provide regular updates to the Controller on status, trends, and any areas of concern.
Qualifications
Required
- 2+ years of experience with Elderly Waiver reimbursement or care coordination
- Experience working in assisted living, home care, or long-term care settings
- Excellent attention to detail and strong organizational skills
- Ability to work collaboratively with clinical, financial, and county partners
Preferred
- Established relationships with county case managers and state billing entities.
- Experience with Eldermark or similar EHR and Medicaid billing systems.
- Experience with CADI or BI waivers
- Prior reimbursement, MDS, or utilization review experience
Education & Certifications
- Bachelor or Associate degree in Nursing, Social Work, Healthcare Administration, or a related field preferred.
- Equivalent experience may be considered in lieu of formal education.
Job Demands:
• Driving to buildings within twin cities metro, should not exceed 45 miles.