Eligibility Specialist I (Adult Medicaid)

Forsyth County (NC); Winston-Salem (NC); On-site; USD 36,000 - 48,000; Full time

Job summary

Forsyth County Department of Social Services seeks an Eligibility Specialist I for Administrative Support in Medicaid Services to support LTC, CAP, and PACE eligibility operations.

You will manage high-volume workflow, document tracking, intake routing, and correspondence with attorneys, providers, and public stakeholders, using NC FAST and office software. This onsite role emphasizes accuracy, confidentiality, and strong customer service in a fast-paced team environment.

Qualifications

• Basic knowledge of Medicaid program structures and standard office practices.
• Basic knowledge of NC FAST or similar eligibility case management systems.
• Ability to distinguish CNRs and Program Change Requests and their impact on CAP code assignments.
• Proficient computer use and document management.
• Strong organizational skills and ability to prioritize multiple assignments.

Responsibilities

• Receives, reviews, tracks, and uploads CNRs and related letters for CAP recipients.
• Reviews CNR documentation for potential CAP code changes requiring staff review.
• Distinguishes documentation-only uploads from cases needing caseworker action.
• Manages Program Change Requests for transitions into SNF, CAP, or other Medicaid programs.
• Ensures completeness of incoming requests and follows up for missing documents.
• Assigns cases using tracking spreadsheets and workflow procedures.
• Maintains logs for CNRs, program changes, UMN requests, and expirations.
• Serves as primary contact for UMN requests from facilities, attorneys, and guardians.
• Routes and tracks PML concerns and CAP code issues; escalates as needed.
• Monitors shared inboxes and routes communications to correct staff.
• Drafts acknowledgment emails and status updates for stakeholders.
• Maintains HIPAA-compliant confidentiality of health and financial information.
• Supports data entry, uploads, and workflow coordination.
• Participates in team meetings and workflow improvement initiatives.

Skills

Organizational skills

Detail-oriented

Communication

Customer service

Microsoft Outlook

Microsoft Word

Excel

Teamwork

HIPAA/compliance

Education

High school diploma or GED

Higher education substitution

Tools

NC FAST

Microsoft Office

Document management systems

Job description

The Forsyth County Department of Social Services is seeking a highly organized, dependable, and detail-oriented professional to serve as an Eligibility Specialist I for Administrative Support within the Medicaid Services Division for programs such as Long Term Care (LTC), Community Alternatives Program (CAP), and Program of All-Inclusive Care for the Elderly (PACE) units.

This position serves as the administrative and operational support backbone for LTC, CAP, and PACE eligibility teams by managing high-volume workflow coordination, document tracking, intake routing, and communication processes that directly support Medicaid eligibility operations. The successful candidate will assist in ensuring accurate and timely processing of Consumer Needs Reassessments (CNRs), Program Change Requests, Unmet Medical Need (UMN) contract requests, FL2 tracking, CAP code coordination, and Patient Monthly Liability (PML) issue routing.

The successful candidate must possess exceptional organizational skills, strong attention to detail, excellent customer service abilities, and the ability to manage multiple competing priorities within structured deadlines in a fast-paced, team-oriented environment. This position requires effective communication with internal and external stakeholders including attorneys, nursing facilities, POAs, legal guardians, medical providers, and Medicaid staff.

The employee must be able to interpret procedural guidance, identify workflow discrepancies, maintain accurate tracking systems, and exercise sound professional judgment regarding routing, escalation, and follow-up actions. The role requires extensive daily use of NC FAST and other electronic systems to upload documents, maintain tracking spreadsheets, process incoming requests, and support Medicaid eligibility operations.

The individual must support the Forsyth County Guiding Principles of WeCare:

Integrity, Awareness, Accountability, Respect, and Excellence.

The successful candidate will demonstrate the ability to manage complex administrative workflows with accuracy, professionalism, and efficiency while supporting Medicaid eligibility staff in Long Term Care, CAP, and PACE operations. The successful candidate will also possess the following knowledge, skills, and abilities:

• Basic knowledge of Medicaid program structures, administrative workflow procedures, and standard office practices, procedures, and equipment.
• Basic knowledge of NC FAST or similar eligibility case management systems.
• Ability to distinguish between Consumer Needs Reassessments (CNRs) and Program Change Requests and understand their impact on CAP code assignments and case processing workflows.
• Skill in operating computers, scanners, calculators, and applicable software programs including Microsoft Outlook, Microsoft Word, Excel, Teams, and electronic document management systems.
• Exceptional organizational skills and the ability to prioritize multiple assignments effectively within structured deadlines and high-volume workflow environments.
• Exceptional customer service skills and the ability to communicate clearly and professionally, both orally and in writing, with individuals from diverse social, economic, cultural, and educational backgrounds.
• Ability to maintain accurate tracking systems, spreadsheets, logs, and electronic records with a high degree of attention to detail.
• Ability to review incoming documentation for completeness and route requests accurately to the appropriate staff member or program area.
• Ability to recognize workflow issues, overdue actions, missing documentation, or escalation-level concerns and notify supervisory staff appropriately.
• Ability to draft professional correspondence, acknowledgment emails, status updates, and routing communications.
• Ability to establish and maintain effective working relationships with colleagues, supervisors, attorneys, medical providers, nursing facilities, POAs, and the general public.
• Ability to work independently while functioning effectively within a collaborative team environment.
• Ability to maintain confidentiality and handle sensitive health and financial information in accordance with HIPAA regulations and agency policies.
• Ability to maintain regular and reliable attendance.
• Ability to thrive in a fast-paced environment while maintaining composure and professionalism under pressure.
• The individual must support the Forsyth County Guiding Principles of WeCare: Integrity, Awareness, Accountability, Respect, and Excellence.

Graduation from high school or GED and two years of paraprofessional or clerical public contact experience which included negotiating, interviewing, explaining information, gathering and compiling of data, analysis of data and/or performance of mathematical or legal tasks;
or graduation from high school or GED and one year of experience in an income maintenance program.
A higher education level may be considered as a substitution for all or part of the experience requirement

• Receives, reviews, tracks, and uploads Consumer Needs Reassessments (CNRs) and Innovation Memo letters for CAP recipients.
• Reviews CNR documentation to determine whether reassessments indicate potential CAP code changes requiring caseworker review prior to upload.
• Distinguishes between documentation-only uploads and cases requiring additional caseworker action before processing.
• Receives and processes Program Change Requests for individuals transitioning into Skilled Nursing Facility (SNF), CAP, or other Medicaid program categories.
• Reviews incoming requests for completeness and returns incomplete submissions with requests for missing documentation as needed.
• Assigns cases to appropriate staff members using established tracking spreadsheets and workflow procedures.
• Maintains organized tracking logs for CNRs, program changes, UMN requests, FL2 expirations, and error referrals.
• Serves as the primary point of contact for incoming Unmet Medical Need (UMN) contract requests from nursing facilities, attorneys, POAs, guardians, and authorized representatives.
• Logs, routes, and tracks UMN requests to ensure timely processing and follow-up.
• Monitors and triages incoming emails related to Patient Monthly Liability (PML) concerns, CAP code issues, and workflow corrections.
• Routes issues to the appropriate caseworker or supervisor for resolution and escalates urgent or unresolved concerns appropriately.
• Monitors shared team inboxes and routes communications to the correct caseworker, supervisor, or Medicaid leadership staff.
• Drafts professional acknowledgment emails, status updates, and correspondence to internal and external stakeholders.
• Maintains confidentiality of sensitive health and financial information in compliance with HIPAA and agency regulations.
• Supports the team with data entry, document uploads, spreadsheet maintenance, and workflow coordination activities.
• Participates in team meetings, trainings, committees, and workflow improvement initiatives as assigned.
• Assists with FL2 expiration tracking for SA and SAIH program participants and notifies caseworkers regarding upcoming expirations.
• Operates computers, scanners, calculators, and other office equipment required to maintain records and process documentation.

Perform related duties as assigned.

These duties are intended only as illustrations of the various types of work performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.

This is an onsite position, Monday through Friday, during standard county business hours, in an office setting. The role requires extensive daily use of computers, electronic systems, spreadsheets, email systems, and document management tools to support Medicaid eligibility operations and workflow coordination.