Benefits & Claims Specialist, PACE Program, Full-time

Hospice Savannah Inc; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Hospice Savannah Inc. seeks a Benefits and Claims Specialist to guide participants through Medicaid applications and to maintain eligibility logs.

The role manages daily claims processing and adjudication, supporting vendors and internal teams while leading the processing function to improve workflows. The position requires an associate degree in Finance, Business, or Healthcare Administration, plus Medicaid system knowledge and 3 years of claims experience; PACE experience is a plus.

Qualifications

• Associate’s degree in Finance, Business, or Healthcare Administration.
• Knowledge of Medicaid system and benefits.
• 3 years of medical claim adjudication/processing experience.
• 1 year of PACE-specific medical claim processing experience.

Responsibilities

• Assist participants and families through the Medicaid application process and maintain logs of Medicaid eligibility.
• Handle day-to-day claims processing and adjudication activities, supporting vendors and internal teams.
• Lead the claims processing function and contribute to workflow development and process improvement initiatives.
• Assist Medicaid Representatives with challenging situations, including meetings with participants, families, social workers, and county personnel.

Skills

Medicaid knowledge

Medical claim adjudication/processing

Claims processing leadership

Workflow improvement

Education

Associate’s degree in Finance, Business or Healthcare Administration

Bachelor’s degree preferred

Job description

a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;}a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;}Job SummaryUnder the supervision of the VP of Finance and the Executive Director, the Benefits and Claims Specialist assists participants and families throughout the Medicaid application process and maintains accurate logs of Medicaid eligibility. The role is responsible for day‑to‑day claims processing and adjudication activities while providing support to vendors and internal teams. As the team lead for the claims processing function, this position also contributes to workflow development, process improvement initiatives, and applies advanced technical expertise to support complex claims scenarios. Additionally, the role assists Medicaid Representatives with challenging situations, which may include meeting with participants, families, social workers, and county personnel.Minimum QualificationsAssociate’s degree in Finance, Business, or Healthcare AdministrationKnowledge of Medicaid system and benefits3 Years of Medical Claim Adjudication/Processing Experience1 Year of PACE Specific Medical Claim Processing ExperienceMust have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.Be medically cleared for communicable diseases and have all immunizations up to-date before engaging in direct participant contact.Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.Competencies, Preferred Knowledge, Skills, and AbilitiesKnowledge of Medicaid system and benefitsBachelor’s degree in Finance, Healthcare Administration, Business, or related field preferredCertified Medical Reimbursement Specialist - American Medical Billing Association preferredPhysical Demands and Work EnvironmentThis position operates in a standard office environment and requires the ability to engage in prolonged periods of computer work, including viewing a screen and performing keyboard and mouse functions. The role requires the ability to communicate clearly in person, over the phone, and electronically. The employee must be able to lift, carry, or move up to 25 lbs for transporting files or materials, as needed. Work may involve occasional interruptions and shifting priorities based on operational needs.Position Type and Expected Hours of WorkThis position may be designated as either full-time, part-time or PRN based on organizational needs. The part-time position is scheduled Monday through Friday, 8:00 a.m. to 12:00 p.m.Travel : None