Medicaid Eligibility Specialist I - LTC/CAP/PACE Admin

Forsyth County (NC); Winston-Salem (NC); On-site; USD 36,000 - 48,000; Full time

Job summary

Forsyth County Department of Social Services seeks an Eligibility Specialist I for Administrative Support in Medicaid Services to support LTC, CAP, and PACE eligibility operations.

You will manage high-volume workflow, document tracking, intake routing, and correspondence with attorneys, providers, and public stakeholders, using NC FAST and office software. This onsite role emphasizes accuracy, confidentiality, and strong customer service in a fast-paced team environment.

Qualifications

• Basic knowledge of Medicaid program structures and standard office practices.
• Basic knowledge of NC FAST or similar eligibility case management systems.
• Ability to distinguish CNRs and Program Change Requests and their impact on CAP code assignments.
• Proficient computer use and document management.
• Strong organizational skills and ability to prioritize multiple assignments.

Responsibilities

• Receives, reviews, tracks, and uploads CNRs and related letters for CAP recipients.
• Reviews CNR documentation for potential CAP code changes requiring staff review.
• Distinguishes documentation-only uploads from cases needing caseworker action.
• Manages Program Change Requests for transitions into SNF, CAP, or other Medicaid programs.
• Ensures completeness of incoming requests and follows up for missing documents.
• Assigns cases using tracking spreadsheets and workflow procedures.
• Maintains logs for CNRs, program changes, UMN requests, and expirations.
• Serves as primary contact for UMN requests from facilities, attorneys, and guardians.
• Routes and tracks PML concerns and CAP code issues; escalates as needed.
• Monitors shared inboxes and routes communications to correct staff.
• Drafts acknowledgment emails and status updates for stakeholders.
• Maintains HIPAA-compliant confidentiality of health and financial information.
• Supports data entry, uploads, and workflow coordination.
• Participates in team meetings and workflow improvement initiatives.

Skills

Organizational skills

Detail-oriented

Communication

Customer service

Microsoft Outlook

Microsoft Word

Excel

Teamwork

HIPAA/compliance

Education

High school diploma or GED

Higher education substitution

Tools

NC FAST

Microsoft Office

Document management systems

Job description

Forsyth County Department of Social Services seeks an Eligibility Specialist I for Administrative Support in Medicaid Services to support LTC, CAP, and PACE eligibility operations.

You will manage high-volume workflow, document tracking, intake routing, and correspondence with attorneys, providers, and public stakeholders, using NC FAST and office software. This onsite role emphasizes accuracy, confidentiality, and strong customer service in a fast-paced team environment.