Regional Medicaid 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

General Purpose

The 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 Duties

• 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 Requirements

Provides 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 Environment

The 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 status

We 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.