Income Maintenance Caseworker I (Adult Medicaid)

Forsyth County•Winston-Salem, NC

2d•Onsite

About The Position

The Forsyth County Department of Social Services is seeking a highly organized, dependable, and detail-oriented professional to serve as an Eligibility Specialist I for Administrative Support within the Medicaid Services Division for programs such as Long Term Care (LTC), Community Alternatives Program (CAP), and Program of All-Inclusive Care for the Elderly (PACE) units. This position serves as the administrative and operational support backbone for LTC, CAP, and PACE eligibility teams by managing high-volume workflow coordination, document tracking, intake routing, and communication processes that directly support Medicaid eligibility operations. The successful candidate will assist in ensuring accurate and timely processing of Consumer Needs Reassessments (CNRs), Program Change Requests, Unmet Medical Need (UMN) contract requests, FL2 tracking, CAP code coordination, and Patient Monthly Liability (PML) issue routing. The successful candidate must possess exceptional organizational skills, strong attention to detail, excellent customer service abilities, and the ability to manage multiple competing priorities within structured deadlines in a fast-paced, team-oriented environment. This position requires effective communication with internal and external stakeholders including attorneys, nursing facilities, POAs, legal guardians, medical providers, and Medicaid staff. The employee must be able to interpret procedural guidance, identify workflow discrepancies, maintain accurate tracking systems, and exercise sound professional judgment regarding routing, escalation, and follow-up actions. The role requires extensive daily use of NC FAST and other electronic systems to upload documents, maintain tracking spreadsheets, process incoming requests, and support Medicaid eligibility operations. The individual must support the Forsyth County Guiding Principles of WeCare: Integrity, Awareness, Accountability, Respect, and Excellence.

Requirements

Graduation from high school or GED and three years of paraprofessional, clerical or other public contact experience which may include negotiating, interviewing, explaining information, gathering and compiling data, analyzing data and/or the performance of mathematical or legal tasks.
Basic knowledge of Medicaid program structures, administrative workflow procedures, and standard office practices, procedures, and equipment.
Basic knowledge of NC FAST or similar eligibility case management systems.
Ability to distinguish between Consumer Needs Reassessments (CNRs) and Program Change Requests and understand their impact on CAP code assignments and case processing workflows.
Skill in operating computers, scanners, calculators, and applicable software programs including Microsoft Outlook, Microsoft Word, Excel, Teams, and electronic document management systems.
Exceptional organizational skills and the ability to prioritize multiple assignments effectively within structured deadlines and high-volume workflow environments.
Exceptional customer service skills and the ability to communicate clearly and professionally, both orally and in writing, with individuals from diverse social, economic, cultural, and educational backgrounds.
Ability to maintain accurate tracking systems, spreadsheets, logs, and electronic records with a high degree of attention to detail.
Ability to review incoming documentation for completeness and route requests accurately to the appropriate staff member or program area.
Ability to recognize workflow issues, overdue actions, missing documentation, or escalation-level concerns and notify supervisory staff appropriately.
Ability to draft professional correspondence, acknowledgment emails, status updates, and routing communications.
Ability to establish and maintain effective working relationships with colleagues, supervisors, attorneys, medical providers, nursing facilities, POAs, and the general public.
Ability to work independently while functioning effectively within a collaborative team environment.
Ability to maintain confidentiality and handle sensitive health and financial information in accordance with HIPAA regulations and agency policies.
Ability to maintain regular and reliable attendance.
Ability to thrive in a fast-paced environment while maintaining composure and professionalism under pressure.

Nice To Haves

Advanced communication skills and customer service experience are preferred.
Previous NC FAST experience preferred.
Bilingual skills (English/Spanish) are a plus.
The preferred candidate possesses a minimum of 1 year experience in Program and 1 year experience in NC FAST

Responsibilities

Receives, reviews, tracks, and uploads Consumer Needs Reassessments (CNRs) and Innovation Memo letters for CAP recipients.
Reviews CNR documentation to determine whether reassessments indicate potential CAP code changes requiring caseworker review prior to upload.
Distinguishes between documentation-only uploads and cases requiring additional caseworker action before processing.
Receives and processes Program Change Requests for individuals transitioning into Skilled Nursing Facility (SNF), CAP, or other Medicaid program categories.
Reviews incoming requests for completeness and returns incomplete submissions with requests for missing documentation as needed.
Assigns cases to appropriate staff members using established tracking spreadsheets and workflow procedures.
Maintains organized tracking logs for CNRs, program changes, UMN requests, FL2 expirations, and error referrals.
Serves as the primary point of contact for incoming Unmet Medical Need (UMN) contract requests from nursing facilities, attorneys, POAs, guardians, and authorized representatives.
Logs, routes, and tracks UMN requests to ensure timely processing and follow-up.
Monitors and triages incoming emails related to Patient Monthly Liability (PML) concerns, CAP code issues, and workflow corrections.
Routes issues to the appropriate caseworker or supervisor for resolution and escalates urgent or unresolved concerns appropriately.
Monitors shared team inboxes and routes communications to the correct caseworker, supervisor, or Medicaid leadership staff.
Drafts professional acknowledgment emails, status updates, and correspondence to internal and external stakeholders.
Maintains confidentiality of sensitive health and financial information in compliance with HIPAA and agency regulations.
Supports the team with data entry, document uploads, spreadsheet maintenance, and workflow coordination activities.
Participates in team meetings, trainings, committees, and workflow improvement initiatives as assigned.
Assists with FL2 expiration tracking for SA and SAIH program participants and notifies caseworkers regarding upcoming expirations.
Operates computers, scanners, calculators, and other office equipment required to maintain records and process documentation.
Performs related duties as assigned.