Medicaid Specialist

Eden Senior Care, LLC; Yeadon (Delaware County); Remote; USD 55,000 - 75,000; Full time

Job summary

Eden East seeks a Medicaid Specialist (Remote) to manage Pennsylvania Medicaid processes for our skilled nursing portfolio. The role supports facility teams, regional leadership, and state agencies, with monthly travel to our homes and a fully remote work setup.

Ideal candidates reside in Pennsylvania, have PCC knowledge, Compass experience, and strong organizational and communication skills to oversee applications, documentation, and inquiries from residents and families.

Qualifications

• Strong organizational, analytical, and problem-solving skills.
• Excellent communication and interpersonal abilities for working with families, residents, and agencies.
• Proficiency in Microsoft Office and Medicaid application software.
• Point Click Care (PCC) knowledge.
• Compass experience.
• Experience in working with County Case Workers.

Responsibilities

• Tracking & Monitoring Medicaid Pending Cases: Submit all Medicaid applications and ensure they have all backup needed to have the application approved.
• Participate in monthly aging calls to stay updated on Medicaid pending cases.
• Regularly review pending cases to ensure accuracy and completeness as well as input notes daily into PCC.
• Case Oversight & Documentation: Ensure appropriate steps are taken and documented for each Medicaid case.
• Work with Medicaid county caseworkers and other resources to track completed Medicaid packets.
• Evaluation & Identification of Potential Medicaid Cases: Proactively assess new admissions, especially those transitioning from skilled care to Medicaid Pending status.
• Serve as the point of contact for all residents / families for Medicaid benefit questions, ensuring timely follow-up.
• Escalation & Problem-Solving: Identify stalled applications and take the lead in addressing them.
• Escalate concerns to Business Office Director & Administrator.
• Training & Support: Collaborate with facility administrators to resolve roadblocks related to Medicaid applications and required documentation.

Job description

EDEN EAST is a portfolio of skilled nursing. As an industry-leading provider of post-acute care, Eden East has been dedicated to changing the way healthcare is delivered. We are passionate about elevating and enhancing our employees as they are the core of the care and love we aim for, cultivating a family-like environment to ensure our residents are treated like family.

We are seeking a Medicaid Specialist who resides in Pennsylvania and has a deep understanding of Medicaid processes. The ideal candidate must be willing to work remotely and travel to any of our skilled nursing homes on a monthly basis, and must be proactive, organized, and committed to problem-solving while working closely with facility teams, regional leadership, and state agencies.

Position: Medicaid Specialist (Remote)

Key Responsibilities:

• Tracking & Monitoring Medicaid Pending Cases:
  • Submit all Medicaid applications and ensure they have all backup needed to have the application approved.
  • Participate in monthly aging calls to stay updated on all Medicaid pending cases.
  • Regularly review pending cases to ensure accuracy and completeness as well as input notes daily into PCC.
• Case Oversight & Documentation:
  • Ensure appropriate steps are taken and documented for each Medicaid case.
  • Work with Medicaid county caseworkers other resources to track completed Medicaid packets.
• Evaluation & Identification of Potential Medicaid Cases
  • Proactively assess new admissions, especially those transitioning from skilled care to Medicaid Pending status.
  • Serve as the point of contact for all residents / families for all Medicaid benefit questions, ensuring timely follow-up.
• Escalation & Problem-Solving
  • Identify stalled applications and take the lead in addressing them.
  • Escalate concerns to Business Office Director & Administrator.
• Training & Support
  • Collaborate with facility administrators to resolve roadblocks related to Medicaid applications and required documentation.

Qualifications:

• Must be residing in Pennsylvania
• In-depth knowledge of Pennsylvania Medicaid application in a skilled nursing setting.
• Compass experience.
• Experience in working with County Case Workers.
• Ability to manage multiple homes and handle new and renewals for Medicaid.
• Experiencing requesting records from banks, Rep Payee applications, Guardian needs.
• Must have Point Click Care (PCC) knowledge.
• Strong organizational, analytical, and problem-solving skills.
• Excellent communication and interpersonal abilities for working with families, residents, and agencies.
• Ability to manage multiple tasks and meet deadlines efficiently.
• Proficiency in Microsoft Office and Medicaid application software.

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