Medicaid Pending Specialist

PAC; Ponte Vedra Beach (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

PAC seeks a Medicaid Pending Resource to develop pending processes, track aging, and train office managers on best practices to improve cash flow.

You will manage a caseload from admission to approval, submit and follow up on applications with eligibility offices, and collect required financial, medical, and legal documents.

The role covers multiple Florida facilities, requires strong Excel and EHR skills (PointClickCare, MatrixCare), and strict adherence to Medicaid rules.

Qualifications

• Minimum four years’ experience in a Skilled Nursing Facility.
• Knowledge of Medicaid eligibility requirements; state-specific knowledge a plus.
• Experience with cash collections, bad debt and DSO.
• Experience with EHR/billing systems.
• Strong organizational and communication skills.
• Willing to travel to Florida facilities.

Responsibilities

• Track and manage a caseload of Medicaid Pending residents from admission through approval.
• Complete, submit, and follow up on Medicaid applications with eligibility offices.
• Coordinate with residents, families, and responsible parties to gather required documents.
• Communicate with facility staff to resolve eligibility issues.
• Monitor aging pending accounts and escalate stalled cases.
• Maintain records in resident management/billing system (PointClickCare, MatrixCare).
• Assist with spend-down documentation, resource assessments, and appeals when denied.
• Ensure compliance with Medicaid regulations and PAC policies.

Skills

Excel

PointClickCare

MatrixCare

Communication

Organization

Multi-tasking

Travel

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

PointClickCare

MatrixCare

Job description

Job DescriptionThis person will spend most of their time developing a Medicaid pending process, tracking Medicaid pending aging’s. This role will include educating and training the office managers on Medicaid pending best practices to ensure positive outcomes with Bad Debt, DSO and Cash Collections. The Medicaid Pending Resource will conduct weekly Medicaid pending aging reviews to look for patterns and trends to see where training is needed. Will be well-versed in all aspects of Florida Medicaid including, Medicaid applications, asset limits, and local Medicaid office case workers.Key ResponsibilitiesTrack and manage a caseload of Medicaid Pending residents from admission through Medicaid approvalComplete, submit, and follow up on Medicaid applications with state/county eligibility officesCoordinate with residents, families, and responsible parties to gather required documentation (financial, medical, legal)Communicate regularly with facility Business Office Managers, Admissions, and Social Services to resolve outstanding eligibility issuesMonitor and report on aging pending accounts; escalate stalled cases to reduce time-to-approvalMaintain accurate, up-to-date records in the resident management/billing system (e.g., PointClickCare, Matrixcare)Ensure compliance with state Medicaid regulations and PACS policiesPartner with Medicaid caseworkers and eligibility agencies to expedite determinationsAssist in spend-down documentation, resource assessments, and appeals when applications are deniedProficient in Excel and PCCQualificationsThe Medicaid Pending Resource should have a minimum of four years’ experience and proven success in a Skilled Nursing Facility.Effective in business office operationsWorking knowledge of Medicaid eligibility requirements (state-specific knowledge a plus)Proven positive outcomes in cash collections, bad debt and DSOExperience with EHR/billing systems (PointClickCare preferred)Strong organizational skills with ability to manage a high-volume caseloadAbility to multi-task in different programs and be able to assist multiple facilities at onceExcellent communication skills for interfacing with families, state agencies, and internal stakeholdersHigh school diploma required; associate's or bachelor's degree preferredMust be flexible and willing to travel to different facilities located in FloridaLeadership abilities that promote a positive work environment while teaching and trainingEffective time management, organizational skills, and detail-orientedPrior experience in a multi-facility or corporate long-term care environmentFamiliarity with Medicaid spend-down, trusts, and asset transfer rules2+ years of experience with Medicaid eligibility, long-term care billing, or skilled nursing preferredThe CandidateThe ideal candidate will be hard-working, detail oriented, team-orientated, service-minded and proactive. Someone who takes pride in providing a high-quality work product and seeks continuous improvement.We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.