Medicaid Specialist

Direction Home Akron Canton Area Agency on Aging & Disabilities; Green (OH); On-site; USD 43,000 - 53,000; Full time

Job summary

Direction Home Akron Canton Area Agency on Aging & Disabilities in Green, OH seeks a Medicaid Specialist to ensure accurate, timely Medicaid eligibility, enrollment, redetermination, and waiver operations across state and managed care systems. The role collaborates with Care Management and Assessment staff and county partners to maintain uninterrupted services.

Responsibilities include processing alerts, maintaining logs, chart closures, and reporting monthly/quarterly data while upholding

Qualifications

• 1 year of relevant experience.
• High School diploma required.
• Preferred: some college; experience with MS Office (Excel/Outlook/Word/Access).

Responsibilities

• Provide enrollee-related support to Care Management and Assessment Departments and staff.
• Process and resolve daily alerts identifying eligibility changes and system discrepancies across Ohio Benefits, PNM, master list, PIMS and MCO portals.
• Complete chart assignments and closures with full documentation and cross-system verification.
• Manage reinstatements of Medicaid eligibility, ensuring timely correction of eligibility interruptions to prevent service gaps.
• Perform Share of Cost processing daily, ensuring accuracy and compliance with waiver requirements.

Skills

Data entry

Insurance billing

Microsoft Office

Education

High School diploma

Some college education

Tools

Excel

Outlook

Word

Access

Job description

Job Details: Job Location: GREEN - UNIONTOWN, OH 44685, Salary Range: $43,400.00 - $52,500.00 Salary/year,

Function(s):

The Medicaid Specialist is responsible for ensuring accurate, timely and compliant Medicaid eligibility, enrollment, redetermination and waiver operations across multiple state and managed care systems.

JOB RESPONSIBILITIES:

• Provide enrollee-related support to Care Management and Assessment Departments and staff
• Process and resolve daily alerts identifying eligibility changes, share of cost updates, plan flips and system discrepancies across Ohio Benefits, Provider Network Management, Master List, PIMS and MCO portals.
• Complete chart assignments and closures with full documentation and cross-system verification.
• Manage reinstatements of Medicaid eligibility, ensuring timely correction of eligibility interruptions to prevent service gaps.
• Perform Share of Cost processing daily, ensuring accuracy and compliance with waiver requirements.
• Process disenrollments across multiple MCO’s including PASSPORT/Assisted Living, MyCare CareSource, Molina, Anthem and Buckeye.
• Complete mailing of State Hearing rights.
• Conduct continuous monitoring of eligibility changes across Ohio Benefits, PNM, master list, PIMS and MCO systems, identifying discrepancies and initiating corrective action.
• Maintain and update tracking logs for state-funded cases, closures, reinstatements, Assisted Living enrollments/disenrollments, share of cost, and other eligibility actions.
• Perform accurate and reconciled monthly and quarterly reporting, including:
  • CareSource Vendor report
  • CareSource billing
  • MAGI report
  • Medicaid Renewal Reports
  • PIMS Waiver Enrollment Report
  • Transitions/Flip reports
  • Suspension Report
  • Molina Audit Report
  • Any evolving reports that are required as Next Generation
• Serve as primary liaison to County JFS, Managed Care Organizations, Ohio Department of Medicaid and Ohio Department of Aging regarding eligibility, Share of Cost and waiver enrollment issues.
• Initiate and track escalations for eligibility errors, system mismatches, and billing discrepancies.
• Coordinate with Care Managers/WSCs to communicate eligibility changes, plan updates and SOC adjustments.
• Advocate for timely Medicaid approvals and resolve conflicts through direct communication with state and county partners.
• Navigate and maintain proficiency in multiple state and program systems, including OB (Ohio Benefits), PNM (Provider Network Management), Master List, PIMS, MCO portals (MyCare CareSource, Moline, Anthem and Buckeye).
• Perform data entry and documentation across all systems.
• Upload required documentation into agency and program-specific systems.

Qualifications:

Required:

• 1 year of relevant experience.
• High School diploma

Preferred:

• Intermediate experience with Microsoft Office programs including Excel, Outlook, Word and Access database use.
• Previous data entry experience
• Previous insurance billing experience
• Some college education