Regional Medicaid Specialist

PAC; Home (PA); On-site; USD 65,000 - 95,000; Full time

Job summary

PAC is seeking a Regional Medicaid Application Specialist to manage Medicaid applications and annual recertifications across multiple skilled facilities in the region. You will ensure timely submissions and coordinate with residents, families, facility staff, and state agencies.

You will oversee the full application lifecycle, conduct interviews and financial reviews, prepare and submit to state agencies, and respond to RFIs while resolving denials and appeals.

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 and related payers.

Responsibilities

• Oversee the Medicaid application lifecycle from initial submission to annual recertification.
• Conduct interviews and financial reviews to collect required documentation.
• Prepare and submit accurate applications to state agencies on time.
• Respond to RFIs, resolve denials/appeals, and support compliance audits.
• Train facility staff on procedures and document requirements.

Skills

Medicaid Eligibility

Application Management

Regulatory Compliance

HIPAA Knowledge

EHR (PointClickCare)

Interviews & Documentation

Regional Travel

Education

Bachelor’s degree in Business/Finance/Social Work

Tools

PointClickCare

EHR Systems

Job description

General PurposeThe Regional Medicaid Application Specialist manages Medicaid applications and recertification's for residents across multiple skilled nursing facilities within a region. This role ensures timely and accurate submissions, minimizing Medicaid Pending and Accounts Receivable exposure. The Specialist serves as the primary expert and liaison for Medicaid eligibility, collaborating with residents, families, facility staff, and government agencies.Essential DutiesMedicaid Eligibility & Application Management· Oversee the full Medicaid application lifecycle, including initial applications and annual recertification.· Conduct interviews and financial reviews with residents and responsible parties to gather requireddocumentation.· 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.Compliance & Documentation· Maintain up-to-date knowledge of federal, state, and local Medicaid regulations.· Ensure accurate record-keeping in electronic and physical files, adhering to HIPAA and companypolicies.· Document case notes, deadlines, and resident payer status in EHR and financial software (e.g., PointClickCare).Regional Support & Reporting· 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/Rexposure.· Collaborate with billing specialists to ensure accurate patient liability management and claim processing.Supervisory RequirementsProvides indirect supervision to facility-level Business Office and Social Services staff involved in the Medicaid process. Exercises independent judgment and decision-making in prioritizing work, resolving escalated cases, and directing regional Medicaid operations.QualificationEducation and/or Experience· Education: Bachelor’s degree in Business, Finance, Social Work, or related field preferred.· Experience: 3–5 years managing Medicaid applications in long-term or post-acute care; regional/multi-facility experience a plus.· Knowledge: Expert knowledge of state Medicaid long-term care eligibility; familiarity with Medicare, Managed Long-Term Care, and other payers is highly desirable.Physical Demands· Requires frequent regional travel to various skilled nursing facilities.· Must be able to work in a typical office setting and interact professionally with residents, families, and governmental agencies.· May require sitting for extended periods and performing data entry tasks.Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters whileperforming the essential functions of this job. Reasonable accommodations may be made to enable individualswith disabilities to perform the essential functions.The noise level in the work environment is usually low to moderate.PACS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected statusWe are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.