Medicaid Eligibility Specialist

FEDlogic, LLC

11d • $52,000 - $65,000 • Remote

About The Position

The Medicaid Eligibility Specialist will bring at least 10 years of progressive experience in Medicaid eligibility across diverse populations and program types. This role will serve as a trusted expert and advisor, helping clients/customers navigate complex Medicaid eligibility policy landscapes, resolve eligibility barriers, and support compliance with state and federal regulations.

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.

Nice To Haves

• Bachelor’s degree in Public Policy, Health Administration, Social Work, or a related field. Master’s degree preferred.
• Knowledge of intersection between Medicaid and other programs such as SNAP, SSI, Medicare and CHIP.
• Prior experience with systems integration or modernization projects related to eligibility.
• Bilingual (Spanish) skills are helpful.
• Great customer service skills and the ability to provide 5 star service.

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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior