Florida Medicaid Pending Eligibility Navigator

PACS; Florida; On-site; USD 52,000 - 76,000; Full time

Job summary

PACS is seeking a Medicaid Pending Resource to develop and manage Medicaid pending processes, educate office managers on best practices, and monitor aging accounts. The role includes training teams to improve bad debt, DSO, and cash collections while ensuring Florida Medicaid compliance.

The ideal candidate will have 4+ years in a Skilled Nursing Facility, demonstrated success in Medicaid eligibility, and experience with EHR/billing systems such as PointClickCare.

Qualifications

• 4 years’ experience in a Skilled Nursing Facility with proven success in office operations.
• Working knowledge of Medicaid eligibility requirements (state-specific knowledge a plus).
• Experience with EHR/billing systems (PointClickCare preferred).
• Strong organizational skills with ability to manage a high-volume caseload.

Responsibilities

• Track and manage a caseload of Medicaid Pending residents from admission through Medicaid approval.
• Submit and follow up on Medicaid applications with state/county eligibility offices.
• Coordinate with residents, families, and responsible parties to gather required documentation.
• Communicate with facility Business Office Managers, Admissions, and Social Services to resolve eligibility issues.
• Monitor aging pending accounts and escalate stalled cases to reduce time-to-approval.
• Maintain accurate records in resident management/billing systems (e.g., PCC, MatrixCare).
• Ensure compliance with Florida Medicaid regulations and PACS policies.
• Partner with Medicaid caseworkers to expedite determinations.
• Assist in spend-down documentation, resource assessments, and appeals when applications are denied.

Skills

Excel

PCC

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

PointClickCare

MatrixCare

Job description

PACS is seeking a Medicaid Pending Resource to develop and manage Medicaid pending processes, educate office managers on best practices, and monitor aging accounts. The role includes training teams to improve bad debt, DSO, and cash collections while ensuring Florida Medicaid compliance.

The ideal candidate will have 4+ years in a Skilled Nursing Facility, demonstrated success in Medicaid eligibility, and experience with EHR/billing systems such as PointClickCare.