Medicaid Specialist

Senior TLC; Charlotte (NC); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

None

Job summary

Senior TLC in Charlotte, NC seeks a Medicaid Specialist to support Medicaid applications and annual recertifications. The role collaborates with Case Managers, Medicaid specialists/paralegals, care teams, participants, and family caregivers to streamline processes and reduce delays.

Qualifications include a high school diploma, 1+ year in Medicaid work with frail elderly populations, and NC driver’s license with reliable vehicle. Immunizations must be up to date.

Qualifications

• Education: High school diploma or equivalent.
• Experience: At least 1 year with frail elderly populations and Medicaid applications.
• Licensure: Valid North Carolina Driver’s License & reliable vehicle.
• Immunizations: Up-to-date vaccines and medical clearance before direct contact.

Responsibilities

• Assist with processing Medicaid applications and annual recertifications; upload documents to CRM and notify DSS.
• Perform administrative tasks and maintain accurate Medicaid records and correspondence.
• Update enrollment status in CRM to ensure accurate reporting to DSS and care teams.
• Interpret Medicaid policy for each PACE application and recertification.
• Coordinate with Case Managers to ensure enrollment and eligibility processes and timely notifications.
• Support Enrollment Administrative Assistant with Medicaid inquiries and guidance.
• Maintain onsite presence to facilitate communication with staff and home visits when needed.
• Lead training meetings with staff on current policies related to PACE Medicaid.
• Communicate enrollment changes to care teams and ensure CRM accuracy and referrals closed.
• Manage relationships with DSS, caseworkers, law firms, and contracted employees for PACE apps.
• Oversee annual documentation updates and reports, including address changes and disenrollments.
• Conduct monthly audits of the Pre-Paid Enrollment Report for Patient Monthly Liabilities.

Skills

Communication

Interpersonal skills

Conflict resolution

Team collaboration

Education

High school diploma or equivalent

Tools

CRM system

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medicaid Specialist

Charlotte, NC, US

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.

Specifications

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

Ages of Patients Rendered Care:

Neonate/Infant Early Childhood Adolescent Adult Geriatric All Age Groups

Key Responsibilities : (*denotes an age-related skill or task)

• 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.