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Medicaid Eligibility Specialist

Remote · Portugal Full-time

Job Description:

  • Provide clients with information and guidance on Medicaid eligibility requirements and benefits
  • Address client inquiries and concerns related to Medicaid applications, renewals, and coverage
  • Manage alternative resources for clients to meet Medicaid eligibility requirements
  • Conduct client education sessions on Medicaid programs and benefits
  • Serve as a subject matter expert on Pennsylvania Medicaid spenddown requirements through clients' pre-care and on-care status
  • Monitor and manage the Medicaid renewal process for existing clients
  • Notify clients of upcoming renewal deadlines and assist with required documentation
  • Ensure renewals are processed timely to avoid lapses in coverage
  • Maintain accurate records of verification processes and outcomes
  • Update patient records in Salesforce to reflect current Medicaid status
  • Design Medicaid eligibility and spenddown processes and trackability reports in Salesforce
  • Serve as a point of contact for Medicaid inquiries from clients, caregivers, and health plan partners
  • Assist clients in understanding Medicaid eligibility, benefits, and application processes
  • Advocate for clients to ensure they receive appropriate Medicaid services
  • Respond to inquiries from patients and healthcare providers regarding Medicaid coverage and eligibility
  • Collaborate with partnering departments, case managers, and healthcare professionals to support patient access to Medicaid benefits
  • Assist with training staff members on Medicaid verification procedures and policies
  • Identify and resolve issues affecting clients' Medicaid eligibility or coverage
  • Work with government agencies and stakeholders to resolve complex Medicaid-related cases

Requirements:

  • Associate's or Bachelor's degree in Social Work, Healthcare Administration, Public Health, or a related field preferred
  • Minimum of 2 years of experience in Medicaid, healthcare, or social services
  • Experience in client support, case management, or benefits coordination
  • Minimum of 2 years of understanding of the Medicaid eligibility and application process for the state of Pennsylvania
  • Excellent organizational and time management skills
  • Proficient in using case management software and other relevant technology
  • Strong communication and interpersonal skills, with the ability to work effectively with diverse populations
  • Ability to analyze complex information and make informed decisions

Benefits:

  • Competitive compensation
  • Medical benefits
  • Retirement plans
  • Wellness programs
  • Fun company events
  • Ongoing learning opportunities to grow your career
  • Inclusive environment
  • Equal Opportunity Employer

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