Medicaid Specialist

Kintegra Health•Gastonia, NC

8d•Onsite

About The Position

The Medicaid Specialist reports to the Director of Community Education (DCE). The role assists with processing Medicaid applications and managing annual recertifications while ensuring compliance with Medicaid regulations. The specialist collaborates with case managers, Medicaid specialists and paralegals, care team members, participants, family caregivers, local Department of Social Services (DSS) staff, and contracted legal personnel to streamline enrollment processes, minimize delays, and improve the participant experience. The position requires a high school diploma or equivalent, at least one year of experience working with the frail elderly population, and at least one year of Medicaid application experience and/or knowledge. A valid North Carolina driver’s license and reliable vehicle are required. The specialist must be medically cleared for communicable diseases and have all immunizations up to date before direct participant contact. The role has no supervisory responsibilities and maintains an onsite presence, with home visits when necessary.

Requirements

High school diploma or equivalent.
At least one year of experience working with the frail elderly population.
At least one year of Medicaid application experience and/or knowledge.
Valid North Carolina driver’s license and reliable vehicle.
Ability to work effectively in a diverse team environment.
Excellent communication, interpersonal, and conflict resolution skills.
Medical clearance for communicable diseases and up-to-date immunizations before engaging in direct participant contact.

Responsibilities

Assist with processing new Medicaid applications and annual recertifications alongside Medicaid specialists and paralegals.
Ensure requested documentation from local DSS is uploaded to the CRM system and communicated appropriately.
Perform administrative tasks related to Medicaid documentation and record-keeping.
Organize and maintain accurate Medicaid records, including applications, supporting documents, and participant correspondence.
Update enrollment status promptly in the CRM system to support accurate reporting to local DSS, care teams, and Medicaid specialist paralegals.
Interpret Medicaid policy and determine how it applies to new PACE applications and annual recertifications.
Coordinate with case managers on enrollment and Medicaid eligibility processes, including timely notifications and information submissions.
Support the Enrollment Administrative Assistant with Medicaid-specific phone inquiries and questions about eligibility, applications, and status updates.
Maintain an onsite presence to facilitate communication with case managers, enrollment directors, and care team members, and facilitate home visits when necessary.
Create and lead training meetings for case managers and other enrollment staff about current and new PACE Medicaid policies.
Communicate enrollment changes and updates to care teams and Medicaid specialists or paralegals, document information accurately in the CRM system, and close referrals as needed.
Maintain working relationships with local DSS and caseworkers for new PACE applications and annual recertifications.
Maintain working relationships with the contracted law firm and contracted employees involved in new PACE applications and annual recertifications.
Manage annual documentation updates and change reports, including address changes, long-term care placements, program disenrollments, and application withdrawals.
Conduct monthly audits of the Pre-Paid Enrollment Report to ensure accurate Patient Monthly Liabilities (PMLs).
Support Senior TLC’s mission, vision, and values.
Perform other duties as assigned.