Medicaid Eligibility Specialist

Oakhill Healthcare; Middleborough (MA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Vacation, sick and holiday pay

Short/Long-term disability

Tuition reimbursement

Life insurance

401K

Job summary

Next Step Healthcare is hiring for a role focused on Medicaid eligibility review and submission across multiple skilled nursing facilities. You will handle financial eligibility applications, maintain grant status, and coordinate with County representatives to expedite information as needed.

The position requires experience in long term care or healthcare, knowledge of Medicaid processes, and strong prioritization skills. Travel to multiple SNFs within the region may be required.

Qualifications

• Preferred college degree with extensive long term care or healthcare experience.
• Knowledge of state Medicaid eligibility requirements and processes.
• Ability to prioritize and manage multiple tasks across sites.

Responsibilities

• Review and approve all Medical Eligibility Applications prior to submission.
• Review, approve, and submit every Medicaid Financial Eligibility Application and attached documentation for assigned SNFs.
• Proactively contact County representative for assigned SNFs to assure applications are progressing.
• Interface with customer or representative to secure new grants and maintain grant status.
• Determine response to Grant Discontinuation and/or Denials with possible appeals.
• Recommend legal or outsourced services to Administrator as needed.
• Communicate billing requirements to SNF based on grant decisions, including retro-adjustments.
• Monitor SNF activity for potential or pending applications and re-determinations.
• Work with SNF to mitigate financial risk from uncooperative customers and escalations.

Skills

Long Term Care experience

Healthcare industry experience

Time and Priority Management

Travel to multi-sites

Medicaid eligibility knowledge

Education

College degree preferred

Job description

Responsibilities include but are not limited to:

• Review and approve all Medical Eligibility Applications prior to submission.
• Review, approve, and submit every Medicaid Financial Eligibility Application and attached documentation for assigned SNFs.
• Proactively contact County representative for assigned SNFs to assure applications are progressing and expedite requests for additional information in advance of formal notice.
• Interface with customer or representative to secure new grants (from County submission until Grant Approval) and to maintain grant status (Eligibility Re-Determinations).
• Determine response to Grant Discontinuation and/or Denials. Lead response, which may include Appeal, Re-Application, or Acceptance.
• Recommend legal or outsourced services to Administrator. May liaise on behalf of SNF.
• Communicate billing requirements to SNF based on Grant Approval or Denial, e.g. Retro-adjustments, Write-off, Adjustments.
• Monitor SNF activity for potential applications, new applications, pending applications (with A/R balances), approved applications, appealed applications, and re-determination of continuous eligibility application.
• Work with SNF to mitigate NSHC financial risk associated with Uncooperative Customers, Process Breakdown, and Administrator Escalations.

Required Qualifications and Skills:

• College degree preferred with a minimum of 5-7 years experience in Long Term Care /Healthcare industry or equivalent experience in County Agency.
• Accounting, Insurance, Paralegal experience may be transferable.
• Proficient in state specific Medicaid Eligibility Requirements & Application Process.
• Proficient in review of Medicaid Applications.
• Time and Priority Management
• Ability to travel to multi-sites within an identified region.

We offer competitive compensation and benefit plans including:

• Vacation, sick and holiday pay
• ST/LT Disability Insurance
• Tuition Reimbursement
• Life Insurance
• 401K

We embrace diversity and are committed to fostering an inclusive workplace for all employees.

Next Step Healthcare is an Equal Opportunity / Aff…

All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin.