Medicaid Specialist

Sanford Treatment Center•Sanford, NC

9h•Onsite

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 Medicaid Specialist works directly with patients and treatment team members to identify barriers to meeting Medicaid requirements and support patients in accessing resources and maintaining appropriate documentation. The position is based at Sanford Treatment Center in the Clinical/Administrative Services department and reports to the Program Director/Regional Director. It is full-time, with hours from 5:30 a.m. to 1:00 p.m.

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.
Explain reporting timeframes, documentation requirements, and methods for submitting information.
Help patients gather and organize documentation supporting 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 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 records of patient contacts, assistance provided, referrals, reported barriers, supporting documentation received, and follow-up activities.
Document patient-reported workforce participation 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 help patients complete follow-up within established timeframes.
Communicate Medicaid concerns or potential coverage interruptions to patients 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 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.