Medicaid Coverage & Enrollment Specialist

OHI; Lakewood Township (NJ); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Medical, Dental, Vision and Life Ins

Flexible Spending Accounts

Job summary

OHI in Lakewood, NJ is seeking a Patient Coverage & Support Specialist to help patients obtain and maintain health coverage through education, outreach, and enrollment assistance. The role focuses on preventing gaps in coverage and coordinating with health plans and internal teams.

You will manage MCO reports, conduct outreach, assist with Medicaid renewals and ACA applications, and maintain accurate, audit-ready documentation in multiple systems.

Qualifications

• > High school diploma or equivalent is required.
• ">Patient centered service; Professional verbal and written communication; ability to explain coverage requirements clearly; strong organization, documentation, follow‑up, and worklist management; confidentiality are required.
• ">Microsoft Office 365 proficiency is required.
• ">Ability to travel to OHI sites and community outreach locations required.
• ">Medicaid and insurance literacy; outreach and engagement; registration accuracy; application and document support; consistent follow‑up; attention to detail; problem solving and escalation; collaboration and accountability; confidentiality and compliance is required.
• ">One to three years in patient access, registration, healthcare eligibility, Medicaid enrollment, financial screening, insurance verification, community outreach, or a related healthcare setting are preferred.
• ">Electronic medical record experience and knowledge of Medicaid renewals, managed care, and public coverage programs are preferred.
• ">Obtain and maintain the certification and authorization required for assigned enrollment duties, including renewal training and continuing program requirements.
• ">Complete required training and certification before independently providing assistance requiring authorization.

Responsibilities

• > Review renewal and redetermination worklists; identify patients approaching deadlines or at risk of losing coverage. Contact patients by telephone and other approved methods, with repeat follow‑up as needed.
• ">Explain Medicaid notices, renewal requirements, deadlines, eligibility processes, and required documents in clear, patient-friendly language.
• ">Help patients complete Medicaid renewals and eligibility and Presumptive Eligibility applications within required training, certification, and authorization. Schedule and conduct enrollment appointments; assist patients with completing and submitting Affordable Care Act (ACA) Marketplace applications, required documentation, and follow‑up.
• ">Help patients gather and submit documents, address incomplete applications and verification requests, and track next steps until resolved, appropriately transferred, or closed under established procedures.
• ">Explain coverage options without directing patients toward a specific plan unless authorized. Refer or escalate complex issues and assistance outside the role’s scope to the appropriate leader, agency, MCO, or certified resource.
• ">Review and complete assigned MCO eligibility, renewal, redetermination, termination, and outreach reports within established timeframes. Research each listed patient, conduct outreach, and document the disposition.
• ">Communicate with MCO representatives about eligibility, discrepancies, renewal concerns, and unresolved cases, consistent with privacy and authorization requirements.
• ">Maintain organized, accurate, audit‑ready records of reports reviewed, contact attempts, patient responses, education, application assistance, documents, barriers, referrals, escalations, and outcomes.
• ">Keep tracking tools aligned with report status. Enter information in Athenahealth, payer portals, enrollment systems, spreadsheets, Monday.com, and other approved systems as assigned.
• ">Meet productivity, quality, and outcome expectations; complete required reporting and alert leadership to unresolved cases, coverage risks, recurring barriers, and workflow improvement opportunities.
• ">Maintain competency in registration workflows, systems, policies, and documentation. Provide basic Patient Liaison coverage during high‑volume periods or staffing shortages while keeping primary coverage responsibilities current.
• ">Pre‑register, register, and check in patients; verify appointments; and assist with scheduling or rescheduling as assigned.
• ">Verify coverage through approved tools and update demographics, emergency contacts, insurance, primary care provider information, and required reporting fields in the electronic medical record.
• ">Collect and accurately file registration forms, consents, and supporting documents. Assist walk‑in patients and connect them with financial screening, enrollment, scheduling, or other appropriate services.

Skills

Patient-centered service

Verbal and written communication

Organization & follow-up

Documentation & record-keeping

Confidentiality

Customer service oriented

Education

High school diploma or equivalent

Tools

Microsoft Office 365

Job description

OHI in Lakewood, NJ is seeking a Patient Coverage & Support Specialist to help patients obtain and maintain health coverage through education, outreach, and enrollment assistance. The role focuses on preventing gaps in coverage and coordinating with health plans and internal teams.

You will manage MCO reports, conduct outreach, assist with Medicaid renewals and ACA applications, and maintain accurate, audit-ready documentation in multiple systems.