Medicaid Eligibility Specialist

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

Benefits offered by this job

Vacation, sick and holiday pay

ST/LT Disability Insurance

Tuition Reimbursement

Life Insurance

401K

Job summary

The Hermitage Healthcare is seeking an experienced Medicaid Eligibility Specialist to review and approve medical eligibility applications and ensure timely submission across multiple SNFs.

The role requires 5–7 years in long-term care or healthcare, a college degree preferred, and proficiency with Medicaid eligibility rules. Travel within the identified region is expected. We offer competitive compensation and comprehensive benefits.

Qualifications

• 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.

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 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 including 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 (Retro-adjustments, Write-off, Adjustments).
• Monitor SNF activity for potential applications, new applications, pending applications, approved applications, appealed applications, and re-determination of continuous eligibility.

Skills

Medicaid knowledge

Time management

Prioritization

Travel readiness

Education

College degree preferred

Job description

The Hermitage Healthcare is seeking an exceptional Medicaid Eligibility Specialist

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.

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