Medicaid Specialist

Kintegra Health•Charlotte, NC

About The Position

The Medicaid Specialist reports to the Director of Community Education and assists with processing Medicaid applications, managing annual recertifications, and ensuring compliance with Medicaid regulations. The role collaborates with case managers, Medicaid specialists and paralegals, care team members, participants, family caregivers, local Department of Social Services (DSS) staff, and contracted legal partners to streamline enrollment, minimize delays, and improve the participant experience. The position maintains Medicaid documentation and records, updates enrollment information in the CRM system, interprets Medicaid policy for PACE applications and recertifications, and supports Medicaid-related inquiries. It also provides training to case managers and enrollment staff, maintains communication with relevant partners, and conducts monthly audits of the Pre-Paid Enrollment Report to verify Patient Monthly Liabilities. The position maintains an onsite presence and may facilitate home visits when necessary. It supports Senior TLC’s mission, vision, and values, and performs other duties as assigned.

Requirements

High school diploma or equivalent.
At least 1 year of experience working with the frail elderly population.
At least 1 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 documentation requested by 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 application forms, supporting documents, and participant correspondence.
Update enrollment status in the CRM system promptly to ensure accurate reporting to DSS, care teams, and Medicaid specialist paralegals.
Interpret Medicaid policy and determine how it applies to new PACE applications and annual recertifications.
Collaborate with case managers to coordinate enrollment and Medicaid eligibility processes, including timely notifications and information submissions.
Support the Enrollment Administrative Assistant by responding to Medicaid-specific phone inquiries and helping address questions and issues related to eligibility, applications, and status updates.
Maintain an onsite presence to improve 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 on 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.
Communicate and maintain relationships with local DSS and caseworkers regarding new PACE applications and annual recertifications.
Communicate and maintain relationships with the contracted law firm and contracted employees involved in processing 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.