Medicaid Eligibility Specialist

Hermitage Skilled Nursing; Mill Street (MA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Vacation and holiday pay

Disability insurance

Tuition reimbursement

Life Insurance

Job summary

Next Step Healthcare is seeking a Medicaid Eligibility Coordinator to review, approve, and submit Medicaid financial eligibility applications for multiple SNFs. This role requires coordination with county representatives, timely processing, and escalation when needed.

The candidate should have 5–7 years in long-term care or a related field, with knowledge of state Medicaid requirements and strong time-management skills. Travel to various sites within the region is expected.

Qualifications

• College degree preferred with 5–7 years in long-term care or county agency experience.
• Accounting, Insurance, Paralegal experience may be transferable.
• Proficient in state-specific Medicaid eligibility requirements and application process.
• Proficient in review of Medicaid applications.
• Time and priority management.
• Ability to travel to multi-sites within identified region.

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 to assure applications are progressing and expedite requests for additional information.
• Interface with customer or representative to secure new grants 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.

Skills

Medicaid Eligibility Knowledge

Medicaid Application Review

Time & Priority Management

Multi-site Travel

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 / Affimative Action Employer

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

We want all interested and qualified candidates to apply for employment opportunities. If you are a U.S. applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us. Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.