Medicaid Specialist

Kintegra Health; Charlotte (NC); On-site; USD 42,000 - 62,000; Full time

Job summary

Kintegra Health in Charlotte, NC seeks a Medicaid Specialist to assist in processing applications and annual recertifications, ensuring compliance with Medicaid regulations. You will collaborate with Case Managers, Paralegals, and care teams to streamline enrollment and improve participant experience.

The role requires strong communication, attention to detail, and the ability to work in a diverse team environment; a valid NC driver’s license is required for field visits.

Qualifications

• High school diploma or equivalent.
• At least 1 year experience with frail elderly population and Medicaid applications.
• Valid North Carolina Driver’s License and reliable vehicle.
• Able to work in a diverse team with strong communication and conflict resolution skills.

Responsibilities

• Assists with processing new Medicaid applications and annual recertifications alongside Medicaid Specialist/Paralegal(s).
• Maintains Medicaid records and supporting documents in the CRM system.
• Updates enrollment status in CRM for accurate reporting to DSS and care teams.
• Interprets Medicaid policy for PACE applications and recertifications.
• Collaborates with Case Managers to coordinate enrollment and eligibility processes.
• Supports enrollment staff with Medicaid-specific inquiries and issue resolution.
• Maintains onsite presence to facilitate communication and home visits when needed.
• Leads training meetings on current policies with PACE Medicaid.
• Communicates enrollment changes to care teams and ensures documentation in CRM.

Skills

Medicaid knowledge

CRM systems

Documentation

Communication

Team collaboration

Policy interpretation

Education

High school diploma

Job description

Job Title

Medicaid Specialist

FLSA Status

Exempt

Salary Range

See Pay Scale

Job Summary

The position reports to the Director of Community Education (DCE). Primary responsibilities include assisting in processing Medicaid applications, managing annual recertifications, and ensuring compliance with Medicaid regulations. The team member will collaborate with Case Managers, Medicaid specialists/paralegals, care team members, participants, and family caregivers to streamline processes, minimize delays, and improve the overall participant experience.

Education

High school diploma or equivalent.

Experience

At least 1 years experience working with the frail elderly population. At least 1 year of Medicaid application experience and/or knowledge required.

Number and Type of Employees Supervised (optional)

None

Licensure, Registry or Certification Required

Valid North Carolina Driver’s License & reliable vehicle

Special Training

Must be able to effectively work in a diverse team environment. Must possess excellent communication, interpersonal and conflict resolution skills.

Immunizations

Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact

Key Responsibilities

• Assists with processing new Medicaid applications and annual recertifications alongside Medicaid Specialist/Paralegal(s). Ensuring that all requested documentation by local Department of Social Services (DSS) is uploaded to the Customer Relationship Management (CRM) system and communicated appropriately.
• Performs administrative tasks related to Medicaid documentation and record-keeping. Organizes and maintains accurate Medicaid records, including application forms, supporting documents, and participant correspondence.
• Manages the timely update of enrollment status in the CRM system to ensure accurate reporting to local DSS, care teams, and Medicaid specialist paralegals.
• Interprets Medicaid policy and determines how policy is applied to for each new PACE application and annual recertification.
• Collaborates with Case Managers to ensure effective coordination of enrollment and Medicaid eligibility processes ensuring timely notifications and submission of information.
• Supports the Enrollment Administrative Assistant by addressing Medicaid-specific phone inquiries offering guidance and support in answering questions and resolving issues related to Medicaid eligibility, applications, and status updates.
• Maintains an onsite presence to enhance communication with Case Managers, enrollment directors, and care team members as well as to facilitate home visits when necessary.
• Creates and leads training meetings with case managers and other enrollment staff to educate on current and new policies with PACE Medicaid.
• Manages the communication of enrollment changes or updates to care teams and Medicaid specialists/paralegals, ensuring all information is documented accurately in the CRM system and referrals are closed, as needed.
• Communicates and maintains relationships with local DSS and caseworkers for new PACE applications and annual recertifications.
• Communicates and maintains relationship with contracted law firm and contracted employee(s) to process new PACE applications and annual recertifications.
• Manages annual documentation updates and change reports, including address changes, long-term care placements, program disenrollments, and application withdrawals.
• Conducts monthly audits of the Pre-Paid Enrollment Report to ensure accurate Patient Monthly Liabilities (PMLs).
• Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.
• Other duties as assigned.