Medicaid Specialist

DIRECTION HOME AKRON CANTON AREA AG•Green, OH

1d•$43,400 - $52,500•Onsite

About The Position

The Medicaid Specialist is responsible for ensuring accurate, timely and compliant Medicaid eligibility, enrollment, redetermination and waiver operations across multiple state and managed care systems.

Requirements

1 year of relevant experience.
High School diploma

Nice To Haves

Intermediate experience with Microsoft Office programs including Excel, Outlook, Word and Access database use.
Previous data entry experience
Previous insurance billing experience
Some college education

Responsibilities

Provide enrollee-related support to Care Management and Assessment Departments and staff
Process and resolve daily alerts identifying eligibility changes, share of cost updates, plan flips and system discrepancies across Ohio Benefits, Provider Network Management, Master List, PIMS and MCO portals.
Complete chart assignments and closures with full documentation and cross-system verification.
Manage reinstatements of Medicaid eligibility, ensuring timely correction of eligibility interruptions to prevent service gaps.
Perform Share of Cost processing daily, ensuring accuracy and compliance with waiver requirements.
Process disenrollments across multiple MCO’s including PASSPORT/Assisted Living, MyCare CareSource, Molina, Anthem and Buckeye.
Complete mailing of State Hearing rights.
Conduct continuous monitoring of eligibility changes across Ohio Benefits, PNM, master list, PIMS and MCO systems, identifying discrepancies and initiating corrective action.
Maintain and update tracking logs for state-funded cases, closures, reinstatements, Assisted Living enrollments/disenrollments, share of cost, and other eligibility actions.
Perform accurate and reconciled monthly and quarterly reporting, including: CareSource Vendor report, CareSource billing, MAGI report, Medicaid Renewal Reports, PIMS Waiver Enrollment Report, Transitions/Flip reports, Suspension Report, Molina Audit Report, and any evolving reports that are required as Next Generation.
Serve as primary liaison to County JFS, Managed Care Organizations, Ohio Department of Medicaid and Ohio Department of Aging regarding eligibility, Share of Cost and waiver enrollment issues.
Initiate and track escalations for eligibility errors, system mismatches, and billing discrepancies.
Coordinate with Care Managers/WSCs to communicate eligibility changes, plan updates and SOC adjustments.
Advocate for timely Medicaid approvals and resolve conflicts through direct communication with state and county partners.
Navigate and maintain proficiency in multiple state and program systems, including OB (Ohio Benefits), PNM (Provider Network Management), Master List, PIMS, MCO portals (MyCare CareSource, Moline, Anthem and Buckeye).
Perform data entry and documentation across all systems.
Upload required documentation into agency and program-specific systems.