MEDICAID BENEFITS & ELIGIBILITY SPECIALIST

PREMIER COMPREHENSIVE SERVICES LLC; Oregon; Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Flexible schedule

Bonus based on performance

Advancement opportunities

Medicaid benefits guidance

Job summary

Premier Comprehensive Services LLC seeks a knowledgeable Medicaid Benefits & Eligibility Specialist to assist individuals navigating Medicaid eligibility, enrollment, reinstatement, and coverage issues related to behavioral health services. You will be a primary resource for those who lost coverage or face interruptions and will guide them through renewals and state procedures.

The role requires strong communication with state agencies, DFCS, and Medicaid representatives, and a compassionate,

Qualifications

• Knowledge of Georgia Medicaid eligibility, enrollment, renewal, and reinstatement processes.
• Experience with Georgia Gateway, DFCS, DCH, or Medicaid-related systems.
• Ability to communicate effectively with state agencies and Medicaid representatives.
• Strong problem-solving, organizational, and follow-up skills.

Responsibilities

• Medicaid Eligibility & Enrollment assistance: help clients apply and understand eligibility; support reinstatement and renewals; interpret notices and required updates.
• Medicaid Reinstatement & Problem Resolution: investigate interruptions, gather documents, liaise with DFCS/DCH and Medicaid, follow up on deadlines.
• Individual & Community Support: identify barriers, educate on renewals, coordinate with PCS staff to prevent gaps in care.
• Administrative Coordination & Documentation: maintain tracking, document assistance, ensure HIPAA compliance and reporting.
• Agency Collaboration: work with leadership, clinical staff, and external resources to reduce interruptions and share renewal knowledge.

Skills

Medicaid eligibility

Enrollment support

Redeterminations

Georgia Gateway

Documentation

Education

High school diploma

Associate’s or Bachelor’s degree preferred

Tools

Microsoft Office

Electronic records

Online application systems

Job description

Benefits

• Bonus based on performance
• Competitive salary
• Flexible schedule
• Opportunity for advancement
• MEDICAID BENEFITS & ELIGIBILITY SPECIALIST

Department

Administrative / Client Support Services

Reports To

COO / VP of Operations / Designee

Employment Classification

W-2 / Contract, as applicable

Position Type

Administrative / Client Support

Service Area

Fulton, DeKalb, Cobb, Gwinnett Counties and surrounding areas

Position Summary

Premier Comprehensive Services, LLC (PCS) is seeking a knowledgeable, detail-oriented, and resourceful Medicaid Benefits & Eligibility Specialist to assist individuals receiving or seeking behavioral health services with Medicaid eligibility, enrollment, reinstatement, and coverage-related issues.

The specialist will serve as a primary resource for individuals who have lost Medicaid coverage, experienced interruptions in benefits, received termination notices, or are having difficulty navigating the Medicaid system.

This position requires a strong working knowledge of Georgia Medicaid, Georgia Gateway, Medicaid eligibility requirements, renewal processes, redeterminations, application procedures, and available resources for individuals experiencing coverage interruptions.

The ideal candidate will be comfortable communicating with state agencies, Medicaid representatives, individuals, families, and community organizations to help resolve eligibility concerns and facilitate the restoration or continuation of healthcare coverage.

Essential Duties and Responsibilities

1. 1. Medicaid Eligibility & Enrollment Assistance
   • Assist individuals with applying for Medicaid and understanding eligibility requirements.
   • Help individuals who have lost Medicaid coverage navigate the reinstatement and reapplication process.
   • Assist with Medicaid renewals, redeterminations, and required eligibility updates.
   • Help individuals understand Medicaid termination, suspension, and denial notices.
   • Assist with identifying missing information or documentation preventing approval.
   • Provide guidance regarding Georgia Medicaid programs and available coverage options.
   • Help individuals navigate Georgia Gateway and other applicable state resources.
   • Monitor application status and follow up on pending eligibility determinations.
   • Assist individuals in understanding Medicaid managed-care enrollment and coverage when applicable.
2. 2. Medicaid Reinstatement & Problem Resolution
   • Investigate and assist with resolving Medicaid coverage interruptions.
   • Help individuals identify why their Medicaid benefits were discontinued.
   • Assist with gathering and submitting requested documentation.
   • Communicate with Georgia Division of Family and Children Services (DFCS), Georgia Department of Community Health (DCH), Medicaid representatives, and other appropriate agencies.
   • Follow up on pending applications, appeals, renewal issues, and eligibility discrepancies.
   • Assist individuals with understanding notices, deadlines, and required next steps.
   • Help individuals navigate the appropriate appeal, reconsideration, or fair-hearing process when applicable.
   • Maintain follow-up records until eligibility concerns are resolved or appropriately referred.
3. 3. Individual & Community Support
   • Work directly with PCS individuals to identify Medicaid coverage barriers.
   • Help individuals understand their responsibilities for maintaining active coverage.
   • Assist with identifying community resources for individuals who do not currently qualify for Medicaid.
   • Provide education regarding renewals, reporting changes, required documentation, and maintaining eligibility.
   • Coordinate with PCS clinical and administrative staff to identify individuals experiencing coverage interruptions.
   • Provide appropriate follow-up to help prevent unnecessary gaps in healthcare access.
   • Maintain a compassionate, patient, and supportive approach when working with individuals who may have difficulty navigating government systems.
4. 4. Administrative Coordination & Documentation
   • Maintain an organized tracking system for Medicaid applications, renewals, reinstatements, and pending cases.
   • Document assistance provided and follow-up activities.
   • Maintain accurate records of eligibility status and relevant correspondence.
   • Protect confidential information and comply with HIPAA and PCS privacy policies.
   • Communicate significant eligibility concerns or unresolved issues to PCS leadership.
   • Provide periodic reports regarding applications submitted, cases resolved, pending cases, and recurring eligibility barriers.
   • Maintain appropriate documentation of all client assistance.
5. 5. Agency Collaboration
   • Collaborate with PCS leadership, clinical staff, billing personnel, and administrative team members.
   • Identify individuals whose Medicaid coverage has lapsed or is at risk of termination.
   • Help reduce service interruptions resulting from preventable eligibility issues.
   • Educate PCS staff on basic Medicaid renewal and eligibility procedures when appropriate.
   • Maintain professional relationships with state agencies, community organizations, and other benefit-navigation resources.

Required Qualifications

• High school diploma or equivalent; associate's or bachelor's degree preferred.
• Demonstrated knowledge of Georgia Medicaid eligibility, enrollment, renewal, and reinstatement processes.
• Experience working with Georgia Gateway, DFCS, DCH, or Medicaid-related systems.
• Previous experience assisting individuals with Medicaid applications, redeterminations, terminations, and coverage restoration.
• Ability to communicate effectively with state agencies and Medicaid representatives.
• Strong problem-solving, organizational, and follow-up skills.
• Ability to interpret Medicaid correspondence and explain requirements in understandable terms.
• Proficiency in Microsoft Office, electronic records, and online application systems.
• Ability to maintain confidentiality and handle sensitive personal and financial information appropriately.
• Strong customer service and interpersonal skills.

Preferred Qualifications

• Two or more years of experience in Medicaid eligibility, benefits navigation, healthcare administration, or social services.
• Experience working with Georgia Medicaid and Medicaid managed-care organizations.
• Experience assisting individuals with behavioral health, mental health, or substance-use treatment needs.
• Familiarity with Georgia Medicaid programs, including Medicaid for children and families, aged/blind/disabled Medicaid, and other applicable eligibility categories.
• Experience with Medicaid renewals, denials, appeals, fair hearings, and reinstatement.
• Knowledge of community assistance programs and social service resources.
• Experience working with underserved or vulnerable populations.

Performance Expectations

• Performance will be evaluated based on: Successful assistance with Medicaid applications and reinstatements.
• Timely follow-up on pending eligibility cases.
• Accuracy of submitted applications and supporting documentation.
• Ability to resolve coverage-related issues.
• Reduction of preventable Medicaid coverage interruptions.
• Quality of communication with individuals and state agencies.
• Accurate tracking and reporting of assigned cases.
• Compliance with PCS confidentiality and documentation requirements.
• Professionalism, dependability, and responsiveness.

Flexible work from home options available.