Regional Medicaid Specialist

(PACS) Providence Administrative Consulting Services, Inc.; Pennsylvania; Hybrid; USD 68,000 - 88,000; Full time

Job summary

Travel regionally, train staff, and produce reports for leadership while coordinating with billing for accurate patient liability and claim processing.

Qualifications

• Bachelor's degree preferred across business, finance, social work, or related field.
• 3–5 years Medicaid applications experience in long-term or post-acute care.
• Knowledge of state Medicaid long-term care eligibility and other payers desirable.

Responsibilities

• Oversee the full Medicaid application lifecycle including initial apps and recertifications.
• Interview residents and responsible parties to gather required documentation.
• Prepare and submit accurate applications to state agencies by deadlines.
• Liaise with government caseworkers, respond to RFIs, resolve complex cases.
• Train facility staff on Medicaid procedures and documentation requirements.
• Travel regionally for support, data collection, and audits.
• Generate leadership reports on Medicaid Pending, deadlines and A/R exposure.
• Collaborate with billing staff to ensure accurate patient liability and claims.

Skills

Medicaid eligibility knowledge

Documentation accuracy

Travel readiness

Stakeholder collaboration

Education

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

Tools

EHR systems

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

Medicaid 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 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.

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 company policies.
• 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/R exposure.
• 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.

Qualification

• 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 while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with 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.

PACS is revolutionizing the delivery and leadership of post-acute healthcare and support services across the country. Originally founded in 2013, the organization now consists of hundreds of independent operating subsidiaries, as well as ancillary and support services. We bring a proven model of mission-driven care that balances access to a national network of support and local decision making. In addition, PACS helps connect exceptional people with premier healthcare careers across the country. We focus on finding innovative and effective team members based on their qualifications, experience, geographic preferences, and personality fit with the existing facility staff and culture. We celebrate diversity and are committed to creating an inclusive environment for all employees. We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic. Employment decisions are based on qualifications, merit, and business needs.