Medicaid Eligibility Specialist I

FreedomCare•Quinte West, ON

4d•Hybrid

About The Position

The Medicaid Eligibility Specialist I focuses on enhancing the patient’s experience by facilitating the approval process, to allow them to receive our service. The Medicaid Specialist responsible for expediting the time it takes for them to enroll into our programs or continue receiving services. The Specialist focuses on maintaining eligibility with current consumers’ service by maintaining active Medicaid status through Medicaid recertification and monthly spend down obligations. The Specialist will be responsible for ensuring compliance with all relevant regulations. The Medicaid Specialist requires a high level of attention to detail, excellent communication skills, and requires in-depth knowledge and understanding of Medicaid policies, regulations, and procedures.

Requirements

2+ years of experience in Medicaid, healthcare, or social services.
2+ years of understanding of the Medicaid eligibility and application process for the state of Colorado.
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.

Nice To Haves

Associate or bachelor's degree in social work, Healthcare Administration, Public Health, or a related field preferred.
Experience in client support, case management, or benefits coordination.

Responsibilities

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 relative to Colorado Medicaid spenddown requirements through the clients’ pre-care & on care status.
Monitor and manage the Medicaid renewal process for existing clients.
Notify clients of upcoming renewal deadlines and assist with the submission of required documentation.
Ensure that renewals are processed in a timely manner to avoid lapses in coverage.
Maintain accurate and detailed records of verification processes and outcomes.
Update patient records in salesforce to reflect current Medicaid status.
Design Medicaid eligibility and spenddown process along with trackability reports in Salesforce.
Serve as a point of contact for Medicaid inquiries from clients, caregivers, and Case Management Agencies.
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.
Work closely with partnering departments to resolve any issues related to Medicaid coverage and recertification.
Assist with training staff members on Medicaid verification procedures and policies.
Collaborate with partnering departments, case managers, and other healthcare professionals to support patients’ access to Medicaid benefits.
Identify and resolve issues that may affect clients' Medicaid eligibility or coverage.
Work with government agencies and other stakeholders to address and resolve complex Medicaid-related cases.