Regional Medicaid Eligibility & Compliance Specialist

PACS; New York (NY); On-site; USD 70,000 - 110,000; Full time

Job summary

PACS in New York is seeking a Regional Medicaid Application Specialist to manage Medicaid applications and recertifications across multiple skilled nursing facilities. You will ensure timely submissions and act as the expert liaison for eligibility with residents, families, staff, and government agencies.

This role requires 3–5 years of Medicaid experience, travel within the region, and collaboration with billing to manage patient liability and AR exposure.

Qualifications

• Bachelor’s degree in Business, Finance, Social Work, or related field preferred.
• 3–5 years managing Medicaid applications in long-term or post-acute care.
• Expert knowledge of state Medicaid long-term care eligibility.

Responsibilities

• Oversee the full Medicaid application lifecycle, including initial applications and annual recertification.
• Conduct interviews and financial reviews with residents and responsible parties to gather required documentation.
• Prepare and submit accurate applications to state agencies within regulatory deadlines.
• Liaise with government caseworkers, respond to RFIs, and resolve complex cases, denials, and appeals.
• Train and guide facility staff on Medicaid application procedures and documentation requirements.
• Travel within the region for support, document collection, and internal compliance auditing.
• Generate reports for leadership on Medicaid Pending accounts, recertification deadlines, and A/R exposure.
• Collaborate with billing specialists to ensure accurate patient liability management and claim processing.

Skills

Medicaid eligibility

Communication

Regional travel

Education

Bachelor’s degree in Business, Finance, Social Work, or related field

Tools

PointClickCare

Job description

PACS in New York is seeking a Regional Medicaid Application Specialist to manage Medicaid applications and recertifications across multiple skilled nursing facilities. You will ensure timely submissions and act as the expert liaison for eligibility with residents, families, staff, and government agencies.

This role requires 3–5 years of Medicaid experience, travel within the region, and collaboration with billing to manage patient liability and AR exposure.