Medicaid Specialist

Lumberton Treatment Center • Lumberton, NC

1d

About The Position

The Medicaid Specialist provides case management and administrative support to patients related to Medicaid eligibility, required reporting, workforce participation requirements, and supporting documentation. The role helps patients understand reporting responsibilities, identify documentation needed to demonstrate compliance, access workforce and community resources, and complete required follow-up activities. The specialist works directly with patients and treatment team members to identify barriers to meeting Medicaid requirements and assists patients in accessing available resources and maintaining appropriate documentation.

This is a full-time position with a stated schedule of 5:30 a.m. to 1:00 p.m. The position reports to the Program Director/Regional Director and is part of Clinical/Administrative Services.

Requirements

• High school diploma or equivalent required.
• Strong organizational, communication, documentation, and follow-up skills.
• Ability to maintain confidentiality and work effectively with patients, clinical staff, governmental agencies, and community organizations.

Nice To Haves

• Associate degree in human services, social work, healthcare administration, behavioral health, or a related field.
• Experience with Medicaid, case management, care coordination, workforce services, social services, or behavioral healthcare.
• Familiarity with North Carolina Medicaid and NCTracks.
• Experience working with individuals receiving substance use disorder treatment.

Responsibilities

• Verify Medicaid eligibility and coverage information through NCTracks and other applicable Medicaid resources.
• Educate patients about applicable Medicaid reporting responsibilities and workforce participation requirements.
• Help patients understand reporting timeframes, documentation requirements, and available submission methods.
• Assist patients with gathering and organizing documentation for reported workforce or other qualifying activities.
• Assist patients with reporting employment, work hours, education, training, volunteer activities, or other qualifying activities, when applicable.
• Help patients identify and document circumstances that may qualify for an exemption or exception from applicable workforce requirements.
• Provide information about employment, education, vocational training, workforce development, and community resources.
• Follow up with patients regarding outstanding documentation, reporting requirements, referrals, and identified needs.
• Maintain accurate documentation of patient contacts, assistance provided, referrals, reported barriers, supporting documentation received, and follow-up activities.
• Document patient-reported workforce participation information in the appropriate organizational record according to established procedures.
• Maintain copies of supporting documentation when permitted and required by organizational policy.
• Track upcoming reporting requirements and assist patients with completing follow-up within established timeframes.
• Communicate Medicaid concerns or potential coverage interruptions to the patient and appropriate treatment team members.
• Assist patients reporting changes in employment, work hours, education, qualifying activities, or other circumstances that may affect Medicaid requirements.
• Maintain professional boundaries and provide assistance within the scope of the Medicaid Specialist role.
• Participate in staff meetings, treatment team activities, training, and quality improvement activities as assigned.
• Maintain confidentiality in accordance with HIPAA, 42 CFR Part 2, applicable Medicaid requirements, and organizational policies.
• Perform other related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED