PACE Medicaid Benefit Specialist - Lynchburg Pace/Full Time 8a-4:30p
About The Position
The PACE Medicaid Benefit Specialist engages, educates, and supports patients and community members throughout the Medicaid lifecycle, from initial applications through annual renewals, eligibility checks, and transitions to other qualifying programs such as Medicare, including for individuals eligible because of age or disability. The role supports access to Medicaid coverage and continuity of care through timely follow-up, ongoing eligibility monitoring, resource verification during intake, and communication with patients and internal teams. The specialist attends weekly Medicaid team meetings, supports coordinated care and enrollment outcomes, conducts monthly eligibility checks for an assigned caseload, and works with patients, social services, eligibility specialists, benefits counselors, external partners, and clinical and care coordination teams. The role also helps identify coverage barriers, maintain knowledge of applicable policies, support team training, contribute to quality improvement, and respond to benefits-related inquiries. Travel is expected 5%–15% of the time.
Requirements
- High school diploma or GED.
- At least three years of experience working with Virginia financial assistance programs.
- Sufficient knowledge to determine and redetermine eligibility for Long Term Care Medicaid benefits in accordance with state, local, and federal guidelines, regulations, and policies.
- Ability to communicate effectively, orally and in writing, with patients, caregivers, state and federal agencies, and medical professionals.
- Ability to comprehend and apply public assistance program policies and regulations to make eligibility determinations.
- Strong computer and analytical skills.
Nice To Haves
- Certification as a Certified Application Counselor (CAC), Virginia Medicaid Enrollment Assister, or related credential.
- Familiarity with managed care organizations (MCOs) operating in Virginia and their roles in Medicaid coverage.
Responsibilities
- Assist with initial Medicaid applications for new enrollments as needed.
- Collect resource verifications and required documentation, ensure applications are accurately submitted, and track submissions.
- Educate applicants about coverage timelines, required follow-ups, and next steps.
- Track patients through the Medicaid enrollment pipeline and support conversion to appropriate programs, such as Medicare for disability-eligible individuals.
- Collaborate with eligibility specialists and PACE team members to maximize program conversions.
- Contact patients proactively to collect renewal documentation and provide renewal guidance, including through home or center visits and delivery of documents to DSS when needed.
- Assist with submitting renewal applications to maintain continuous coverage.
- Record patient interactions and follow-ups in internal systems and coordinate with social services to track renewal status.
- Attend and contribute to weekly Medicaid meetings, share updates on conversions and renewals, identify coverage barriers, and recommend process improvements.
- Conduct monthly Medicaid eligibility verifications for an assigned caseload, update patient records, and flag discrepancies for follow-up.
- Promptly notify patients about lapses, changes, or upcoming eligibility deadlines.
- Identify Medicaid patients who may qualify for Medicare due to disability, educate them about potential eligibility and application steps, and coordinate transitions with internal benefits counselors or external partners.
- Assist with training new team members or interns on Medicaid processes and workflows.
- Maintain current knowledge of federal and state Medicaid policies, including eligibility, application, and redetermination requirements.
- Provide backup support to other benefit team members during high-volume periods or staff absences.
- Collaborate with social work, care coordination, and clinical teams to identify patients at risk of losing coverage and intervene proactively.
- Participate in quality improvement initiatives or audits related to benefits access, data accuracy, or enrollment outcomes.
- Develop or revise patient education materials about Medicaid and other benefit programs.
- Respond to inquiries from patients, caregivers, or external agencies about Medicaid and related benefits.
- Perform other assigned duties or projects related to patient financial advocacy, benefits optimization, or continuity of coverage.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
High school or GED
