Medicaid Eligibility Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Medicaid Eligibility Specialist guiding clients and customers through complex Medicaid eligibility rules. Analyzing cases and supporting compliance with state and federal regulations.
Responsibilities:
- Serve as a subject matter expert on Medicaid eligibility rules, including MAGI, ABD, Medically Needy, and waiver programs.
- Analyze complex eligibility cases and provide technical assistance to internal and external stakeholders.
- Interpret and apply state and federal regulations, CMS guidance, and waiver provisions to real-world eligibility scenarios.
- Support system design, testing, and policy implementation related to Medicaid eligibility.
- Develop and deliver training and reference materials for eligibility workers, supervisors, and partners.
- Assist in quality assurance efforts by conducting case reviews and identifying policy gaps or training needs, when needed.
- Liaise with our customers and state and federal agencies on eligibility policy clarifications and updates.
- Any other tasks as assigned by Leadership.
Requirements:
- Minimum 10 years of direct experience in Medicaid eligibility determination, policy analysis or training.
- Minimum 3 years of customer service, healthcare navigation, benefits administration, or case management experience.
- Deep understanding of Medicaid eligibility rules under SSA, CMS, and state-specific implementations.
- Demonstrated experience with 1634 and 209(b) state models, spend-down programs and eligibility systems.
- Strong analytical and documentation skills and be detail oriented.
- Strong writing, communication, and stakeholder engagement skills.
- Experience working in a fast-paced, service-oriented environment.
- Prolonged sitting and computer work.
- Must be able to handle confidential sensitive medical information.
- Proficiency with Customer Relationship Management systems (i.e. Salesforce and Tableau), workforce management tools, Google Workplace, Slack and minimal usage of Microsoft Office Suite.
Benefits:
- Flexible remote work environment
- Paid Time Off (PTO) plus all federal holidays off
- Comprehensive benefits package with health, dental, vision insurance group term life, short term disability, long term disability and voluntary life plans.
- Numerous supplemental plans to assist employees.
- Paid maternity, paternity and adoption leave benefits.
- Cancer Experts Now - supplemental plan
- 401(k) retirement plan with matching contributions.
- Supportive and collaborative work environment.
- Opportunity to be part of a rapidly growing company dedicated to making a difference in the lives of families.
Similar Jobs
Senior Application Specialist
Senior Application Specialist providing phone-based technical support and guidance for Paciolan’s software products. Collaborating with Customer Service teams to resolve client inquiries and enhance customer experience.
Senior Application Specialist
Senior Application Specialist ensuring clients effectively understand and utilize Paciolan’s products. Delivering support and guidance to enhance overall customer experience while collaborating with teams.
Pharmacovigilance Specialist
Pharmacovigilance Specialist managing SAE data collection and reporting at Worldwide Clinical Trials. Ensuring regulatory compliance in a dynamic, global environment with a focus on patient safety.
Behavioral Specialist – Telehealth, Virtual
Behavior Specialist providing telehealth support and psychoeducational groups at Rogers Behavioral Health. Collaborating virtually to facilitate behavioral interventions and support efforts.
Automation Specialist
Automation Specialist improving operational efficiency through process improvements and automation solutions at BlueCross BlueShield of South Carolina. Collaborating with department stakeholders and supporting continuous improvement initiatives.
Underwriter – Unsupported Excess Casualty
Underwriter managing E&S Casualty portfolio for Paragon Insurance Holdings. Focusing on growth and profitability while building broker relationships in North America.
Renewal Underwriter – Casualty E&S
Renewal Underwriter managing Excess & Surplus lines casualty portfolio at Paragon Insurance Holdings. Evaluating risks and underwriting renewal submissions for profitable growth objectives.
Lead Renewals Specialist – Splunk
Lead the Splunk Renewals team in ensuring customer retention and renewal rate growth. Collaborate cross-functionally to meet strategic objectives and drive operational excellence.
Renewals Specialist – Splunk
Renewals Specialist at Cisco enhancing product experience for customers and partners in the LATAM territory. Collaborating cross-functionally to support and execute renewal motions while tackling customer challenges.
Medical Specialist – Medical Second Opinion
Medical Specialist providing asynchronous second opinions on complex medical cases through a user-friendly platform. Join a network of Canadian specialists transforming healthcare.
Specialist Physician, Second Medical Opinion
Medical Specialist providing remote second opinions on diagnoses and treatment plans in Canada. Joining an innovative health platform transforming healthcare delivery in Canada.
Proposal Specialist
Proposal Specialist preparing proposals and supporting client services in a Contract Research Organization. Collaborating with teams to advance human health in a fully remote role.
Maternal Mortality Review Coordinator
Maternal Mortality Review Coordinator supporting critical public health programs by analyzing maternal healthcare delivery in Florida. Collaborating with virtual teams and conducting qualitative research to pinpoint biases in outcomes.
Environmental Lead
Environmental Lead overseeing community and environmental standards for OpenAI's data center projects. Responsible for risk assessment and ensuring regulatory compliance throughout project lifecycle.
Child & Family Support Worker
Child and Family Remote Support Worker at UnitingCare supporting early childhood development and family relationships in rural Queensland communities. Role involves travel and working with vulnerable families.
Global Study Lead
Study Lead at ICON coordinating project activities in a global healthcare organization. Focused on project delivery, stakeholder engagement, and team management within the clinical research domain.
Product Line Leader
Product Line Manager responsible for achieving financial goals through product strategy and management at Afinitas. Collaborating across functions to drive growth and market competitiveness.
Senior Service Specialist, Diesel Engines
Senior Service Specialist providing technical support and training for diesel engines at Rehlko. Troubleshooting warranty claims and building relationships with dealers in the USA.
Resource Center Specialist, Weekend Day Shift
Resource Center Specialist performing document processing and administrative support tasks for a leading global law firm. Collaboration with internal teams and adapting to modern software tools is essential.
Construction Contract Lead
Contract Lead overseeing contract development and administration for construction projects at American Red Cross. Managing supplier relationships and leading volunteers in project activities.