[Hiring] Medicaid Eligibility Specialist @FreedomCare

Role Description

The Medicaid Eligibility Specialist focuses on enhancing the patient’s experience by facilitating the approval process, allowing them to receive our service. The Specialist is responsible for expediting the time it takes for clients to enroll in our programs and maintaining eligibility with current consumers by ensuring active Medicaid status through recertification and monthly spend down obligations.

The Specialist will ensure compliance with all relevant regulations and requires a high level of attention to detail, excellent communication skills, and in-depth knowledge of Medicaid policies, regulations, and procedures.

Every Day You Will:

• Medicaid Eligibility:
  • Provide clients with information and guidance on Medicaid eligibility requirements and benefits.
  • Address client inquiries and concerns related to Medicaid applications, renewals, and coverage.
  • Manage alternative resources for clients to meet Medicaid eligibility requirements.
  • Conduct client education sessions on Medicaid programs and benefits.
  • Be a subject matter expert on Pennsylvania Medicaid spenddown requirements through clients’ pre-care and on-care status.
• Medicaid Renewal Processing:
  • Monitor and manage the Medicaid renewal process for existing clients.
  • Notify clients of upcoming renewal deadlines and assist with the submission of required documentation.
  • Ensure that renewals are processed in a timely manner to avoid lapses in coverage.
• Documentation and Record Keeping:
  • Maintain accurate and detailed records of verification processes and outcomes.
  • Update patient records in Salesforce to reflect current Medicaid status.
  • Design Medicaid eligibility and spenddown processes along with trackability reports in Salesforce.
• Communication:
  • Serve as a point of contact for Medicaid inquiries from clients, caregivers, and health plan partners.
  • Assist clients in understanding Medicaid eligibility, benefits, and application processes.
  • Advocate for clients to ensure they receive appropriate Medicaid services.
  • Respond to inquiries from patients and healthcare providers regarding Medicaid coverage and eligibility.
• Collaboration and Support:
  • Work closely with partnering departments to resolve any issues related to Medicaid coverage and recertification.
  • Assist with training staff members on Medicaid verification procedures and policies.
  • Collaborate with partnering departments, case managers, and other healthcare professionals to support patients’ access to Medicaid benefits.
  • Identify and resolve issues that may affect clients' Medicaid eligibility or coverage.
  • Work with government agencies and other stakeholders to address and resolve complex Medicaid-related cases.

Qualifications

• Associate's or Bachelor's degree in Social Work, Healthcare Administration, Public Health, or a related field preferred.
• Minimum of 2 years of experience in Medicaid, healthcare, or social services.
• Experience in client support, case management, or benefits coordination.
• Minimum of 2 years of understanding of the Medicaid eligibility and application process for the state of Pennsylvania.
• Excellent organizational and time management skills.
• Proficient in using case management software and other relevant technology.
• Strong communication and interpersonal skills, with the ability to work effectively with diverse populations.
• Ability to analyze complex information and make informed decisions.

Benefits

• Competitive compensation.
• Medical benefits.
• Retirement plans.
• Wellness programs.
• Fun company events.
• Ongoing learning opportunities to grow your career.