Medicaid Specialist PACE

Franciscan Health•Flexible Work Location, IN

7d•Hybrid

About The Position

The PACE Medicaid Specialist leads all Medicaid eligibility activities across the program, including applications, reactivations, and annual redeterminations. In this role, you will own process performance, ensuring consistent execution, accountability, and measurable outcomes. You will also ensure complete, accurate, and timely submissions to the State of Indiana for approval of prospective participants and continued eligibility of current participants. Through proactive management of applications and redeterminations, this role advances census growth, prevents coverage gaps, and protects participant access to care and program revenue integrity.

Requirements

High School Diploma/GED - Required
2 Years - Direct Medicaid eligibility experience, including applications, reactivations, and redeterminations - Required
1 Year - Strong knowledge of Indiana Medicaid eligibility requirements, verification processes, and state systems - Required
1 Year - Experience working directly with FSSA/DFR, including escalation of complex eligibility cases - Required
1 Year - Proven ability to independently manage cases from submission through resolution with limited oversight - Required
1 Year - Experience working with a frail or elderly population - Required
Driver's License - Required
Auto Insurance - Required

Nice To Haves

Associate's Degree - Relevant Field of Study - Preferred
1 Year - Experience in PACE, long-term care, or healthcare enrollment - Preferred

Responsibilities

Own and execute all Medicaid redeterminations, maintaining accountability for continuous participant coverage.
Proactively manage timelines, prioritizing outreach and follow-up to prevent eligibility gaps and disenrollment.
Identify, assess, and resolve risks impacting continued eligibility, determining appropriate actions to sustain coverage.
Oversee Medicaid applications and reactivations, advancing cases from initiation through submission with a focus on timely outcomes.
Assess applicant readiness in partnership with Intake, resolve eligibility barriers, and establish next steps to support enrollment.
Collect, verify, and submit documentation through direct outreach and in-person engagement to reduce delays and improve application completeness.
Manage application pipelines and coordinate follow-up and escalation with FSSA/DFR to accelerate determinations.
Act as the primary Medicaid eligibility resource for Intake, Social Work, and the interdisciplinary team.
Align stakeholders on documentation requirements, timelines, and clear next steps, prioritizing cases based on urgency and impact.