Medicaid Specialist

Lumberton Treatment Center; Lumberton (NC); On-site; USD 38,000 - 56,000; Full time

Job summary

Lumberton Treatment Center in Lumberton, NC seeks a Medicaid Specialist to provide case management and administrative support for Medicaid eligibility and reporting, collaborating with the treatment team.

The role focuses on guiding patients through NCTracks processes, gathering documentation, and ensuring timely follow-up, while maintaining HIPAA confidentiality and contributing to quality improvement initiatives.

Qualifications

• High school diploma or equivalent is required.
• An associate degree in human services, social work, healthcare administration, behavioral health, or related field is preferred.
• Experience with Medicaid, case management, care coordination, workforce services, social services, or behavioral healthcare is preferred.
• Familiarity with North Carolina Medicaid and NCTracks is preferred.
• Experience with individuals in substance use disorder treatment is preferred.
• Strong organizational, communication, documentation, and follow-up skills.
• Ability to maintain confidentiality and work effectively with patients, staff, and agencies.

Responsibilities

• Verify Medicaid eligibility and coverage information through NCTracks and other Medicaid resources.
• Educate patients regarding Medicaid reporting responsibilities and workforce participation requirements.
• Assist patients with understanding reporting timeframes and documentation requirements.
• Help patients gather and organize documentation to support reported activities.
• Assist patients with reporting employment, education, training, volunteer activities, or other qualifying activities.
• Identify circumstances that may qualify for exemptions or exceptions from workforce requirements.
• Provide information regarding employment, education, vocational training, and community resources.
• Follow up with patients on outstanding documentation, reporting requirements, referrals, and needs.
• Maintain accurate documentation of patient contacts, assistance, referrals, barriers, and follow-up activities.
• Document patient-reported workforce information in appropriate records per procedures.
• Maintain copies of supporting documentation as required by policy.
• Track upcoming reporting requirements and assist with follow-up within timeframes.
• Communicate Medicaid concerns or potential coverage interruptions to patients and treatment team.
• Assist patients reporting changes in employment or other circumstances affecting Medicaid requirements.
• Maintain professional boundaries within the scope of the Medicaid Specialist role.
• Participate in staff meetings, treatment team activities, training, and quality improvement activities.
• Maintain confidentiality per HIPAA, 42 CFR Part 2, and organizational policies.
• Perform other related duties as assigned.

Skills

Organizational skills

Communication skills

Documentation

Follow-up

Confidentiality

HIPAA compliance

Education

High school diploma or equivalent

Associate degree in related field

Tools

NCTracks

Medicaid systems

Job description

Department: Clinical/Administrative Services.

Reports To: Program Director/Regional Director.

Employment Status: Full-Time 5:30am to 1:00pm.

Position Summary:

The Medicaid Specialist provides case management and administrative support to patients related to Medicaid eligibility, required reporting, workforce participation requirements, and supporting documentation. The position assists patients in understanding reporting responsibilities, identifying documentation needed to demonstrate compliance, accessing appropriate workforce and community resources, and completing required follow-up activities. The Medicaid Specialist works directly with patients and members of the treatment team to identify barriers that may interfere with a patient's ability to meet Medicaid requirements and assists the patient with accessing available resources and maintaining appropriate documentation.

Essential Duties and Responsibilities:

• Verify Medicaid eligibility and coverage information through NCTracks and other applicable Medicaid resources.
• Educate patients regarding applicable Medicaid reporting responsibilities and workforce participation requirements.
• Assist patients with understanding required reporting timeframes, documentation requirements, and available methods for submitting information.
• Assist patients with gathering and organizing documentation needed to support reported workforce activities or other qualifying activities.
• Assist patients with reporting employment, work hours, education, training, volunteer activities, or other qualifying activities, when applicable.
• Assist patients with identifying and documenting circumstances that may qualify for an exemption or exception from applicable workforce requirements.
• Provide patients with information regarding employment, education, vocational training, workforce development, and community resources.
• Follow up with patients regarding outstanding documentation, reporting requirements, referrals, and identified needs.
• Maintain accurate documentation of patient contacts, assistance provided, referrals, reported barriers, supporting documentation received, and follow-up activities.
• Document patient-reported workforce participation information in the appropriate organizational record according to established procedures.
• Maintain copies of supporting documentation when permitted and required by organizational policy.
• Track upcoming reporting requirements and assist patients with completing required follow-up within established timeframes.
• Communicate identified Medicaid concerns or potential interruptions in coverage to the patient and appropriate members of the treatment team.
• Assist patients who report changes in employment, work hours, education, qualifying activities, or other circumstances that may affect Medicaid requirements.
• Maintain appropriate professional boundaries and provide assistance within the scope of the Medicaid Specialist role.
• Participate in staff meetings, treatment team activities, training, and quality improvement activities as assigned.
• Maintain confidentiality in accordance with HIPAA, 42 CFR Part 2, applicable Medicaid requirements, and organizational policies.
• Perform other related duties as assigned.

Minimum Qualifications:

• High school diploma or equivalent required.
• Associate degree in human services, social work, healthcare administration, behavioral health, or a related field preferred.
• Experience with Medicaid, case management, care coordination, workforce services, social services, or behavioral healthcare preferred.
• Familiarity with North Carolina Medicaid and NCTracks preferred.
• Experience working with individuals receiving substance use disorder treatment preferred.
• Strong organizational, communication, documentation, and follow-up skills.
• Ability to maintain confidentiality and work effectively with patients, clinical staff, governmental agencies, and community organizations.