Medicaid Pending Specialist

PACS

1d•Hybrid

About The Position

This person will spend most of their time developing a Medicaid pending process, tracking Medicaid pending aging’s. This role will include educating and training the office managers on Medicaid pending best practices to ensure positive outcomes with Bad Debt, DSO and Cash Collections. The Medicaid Pending Resource will conduct weekly Medicaid pending aging reviews to look for patterns and trends to see where training is needed. Will be well-versed in all aspects of Florida Medicaid including, Medicaid applications, asset limits, and local Medicaid office case workers.

Requirements

Minimum of four years’ experience and proven success in a Skilled Nursing Facility
Effective in business office operations
Working knowledge of Medicaid eligibility requirements (state-specific knowledge a plus)
Proven positive outcomes in cash collections, bad debt and DSO
Experience with EHR/billing systems (PointClickCare preferred)
Strong organizational skills with ability to manage a high-volume caseload
Ability to multi-task in different programs and be able to assist multiple facilities at once
Excellent communication skills for interfacing with families, state agencies, and internal stakeholders
High school diploma required
Must be flexible and willing to travel to different facilities located in Florida
Leadership abilities that promote a positive work environment while teaching and training
Effective time management, organizational skills, and detail-oriented
Prior experience in a multi-facility or corporate long-term care environment
Familiarity with Medicaid spend-down, trusts, and asset transfer rules
2+ years of experience with Medicaid eligibility, long-term care billing, or skilled nursing preferred
Hard-working, detail oriented, team-orientated, service-minded and proactive
Takes pride in providing a high-quality work product and seeks continuous improvement

Nice To Haves

Associate's or bachelor's degree preferred

Responsibilities

Track and manage a caseload of Medicaid Pending residents from admission through Medicaid approval
Complete, submit, and follow up on Medicaid applications with state/county eligibility offices
Coordinate with residents, families, and responsible parties to gather required documentation (financial, medical, legal)
Communicate regularly with facility Business Office Managers, Admissions, and Social Services to resolve outstanding eligibility issues
Monitor and report on aging pending accounts; escalate stalled cases to reduce time-to-approval
Maintain accurate, up-to-date records in the resident management/billing system (e.g., PointClickCare, Matrixcare)
Ensure compliance with state Medicaid regulations and PACS policies
Partner with Medicaid caseworkers and eligibility agencies to expedite determinations
Assist in spend-down documentation, resource assessments, and appeals when applications are denied