Medicaid Enrollment Specialist

Veracity Ventures Inc.•Newark, NJ

2h•$58,000 - $77,000

About The Position

The Medicaid Enrollment Specialist is responsible for successfully enrolling prospective participants in Medicaid, with a focus on Medi-Cal enrollment. The position is part of the Marketing, Outreach, and Enrollment (MOE) team and works directly with prospective participants, county Department of Public and Social Services (DPSS) representatives, and internal enrollment teams to ensure applications are complete, submitted on time, and followed through to approval. The role requires strong knowledge of Medicaid enrollment rules and complex case management, including share of cost, spousal impoverishment protections, and appeals processes. The specialist may visit seniors' homes to collect documentation, coordinate enrollment activities with county offices, and conduct community and virtual enrollment events. The position is based in Newark, New Jersey, and requires occasional travel for home visits and community enrollment events.

Requirements

At least three years of experience working directly with county DPSS submitting, managing, and appealing Medicaid enrollments.
Demonstrated knowledge and experience with complex Medicaid enrollment case management.
Strong knowledge of Medicaid enrollment rules, processes, and practices.
Experience managing Medicaid application submissions, follow-ups, and appeals.
Ability to maintain effective working relationships with county DPSS representatives.
Strong communication, organization, documentation, and follow-up skills.
Direct Medicaid enrollment knowledge and experience; general healthcare administration or insurance verification experience alone does not meet this requirement.
Minimum education listed: High School Diploma or Equivalent.
Comfort with occasional travel for home visits and community enrollment events.

Nice To Haves

Bachelor's degree in a relevant field.
An additional five years of relevant Medicaid enrollment experience may be substituted for the preferred bachelor's degree.
Spanish-English bilingual communication skills.
Experience working directly with senior participants and individuals navigating complex healthcare enrollment requirements.
Experience organizing community-based and virtual enrollment events.

Responsibilities

Gather necessary documentation and prepare complete Medicaid enrollment applications.
Create and submit Medicaid applications for prospective participants.
Follow up diligently on submitted applications to support successful enrollment.
Monitor pending applications and coordinate with relevant parties to address missing information or delays.
Manage Medicaid enrollment cases through the application and determination process.
Support and appeal Medicaid enrollment denials when necessary.
Visit seniors' homes as needed to gather required application documentation.
Explain documentation requirements to prospective participants and coordinate collection of supporting records and information.
Ensure applications are complete and submitted within applicable deadlines.
Maintain working relationships with county DPSS representatives and coordinate with county offices to support an effective enrollment workflow.
Follow up on applications and outstanding documentation, adhere to deadlines and applicable policies, and comply with DHCS and CMS guidelines and policies.
Follow applicable marketing guidelines and Medicaid denial policies.
Create and conduct Medicaid enrollment events to attract prospective participants.
Conduct weekly enrollment events at each WelbeHealth center within the assigned territory.
Organize monthly enrollment events at senior housing communities, hospitals, senior centers, and churches.
Conduct monthly virtual Medicaid enrollment sessions.
Provide backup and support to Outreach and Enrollment functions as assigned.
Help prospective participants navigate complex Medicaid matters, including share of cost, spousal impoverishment protections, enrollment options, denials, and appeals.