Medicaid Eligibility Support Specialist I (LTC/CAP/PACE)

Forsyth-County,-Nc; East Winston (NC); On-site; USD 42,000 - 56,000; Full time

Job summary

Forsyth County Department of Social Services is seeking an Eligibility Specialist I to provide administrative support for Medicaid services (LTC, CAP, PACE). You will coordinate high-volume workflows, manage documents, route intake, and support eligibility operations with accuracy and professionalism.

The role requires strong organization, attention to detail, and the ability to communicate effectively with attorneys, facilities, and Medicaid staff.

Qualifications

• High school diploma or GED plus two years paraprofessional/clerical public contact experience; substitute with higher education.
• Must be able to interpret guidance, manage workflows, and maintain accurate tracking across systems.
• Demonstrated ability to handle confidential information and work with diverse stakeholders.

Responsibilities

• Receive, review, track, and upload CNRs and Innovation Memo letters for CAP recipients.
• Review CNR documentation to determine CAP code changes requiring caseworker review.
• Distinguish between documentation-only uploads and cases needing additional staff action.
• Process Program Changes for SNF, CAP, or other Medicaid categories.
• Ensure submissions are complete and request missing documents as needed.
• Assign cases using tracking spreadsheets and workflow procedures.
• Maintain logs for CNRs, program changes, UMN requests, and FL2 expirations.
• Serve as the primary contact for UMN requests from facilities, attorneys, POAs, guardians, and reps.
• Monitor emails related to PML concerns, CAP code issues, and workflow corrections.
• Route issues to the appropriate staff and escalate urgent matters.
• Draft acknowledgement emails, status updates, and routine correspondence.
• Maintain confidentiality per HIPAA and agency policies.

Skills

NC FAST knowledge

Office software

Communication skills

Organizational skills

Attention to detail

HIPAA confidentiality

Education

High school diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Excel

Microsoft Teams

Electronic document management systems

Job description

Forsyth County Department of Social Services is seeking an Eligibility Specialist I to provide administrative support for Medicaid services (LTC, CAP, PACE). You will coordinate high-volume workflows, manage documents, route intake, and support eligibility operations with accuracy and professionalism.

The role requires strong organization, attention to detail, and the ability to communicate effectively with attorneys, facilities, and Medicaid staff.