PACE Medicaid Benefit Specialist - Lynchburg Pace/Full Time 8a-4:30p

Centra Health•Lynchburg, VA

About The Position

The PACE Medicaid Benefit Specialist engages, educates, and supports patients and community members throughout the Medicaid lifecycle, including initial applications, annual renewals, eligibility checks, and transitions to other qualifying programs such as Medicare. The specialist helps ensure 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 role also participates in regular Medicaid team meetings to coordinate care and improve enrollment outcomes. The position supports Medicaid intake and applications, tracks enrollment and program conversions, assists patients with renewals, verifies eligibility monthly for an assigned caseload, and follows up with Medicaid-only patients who may qualify for Medicare due to disability. It collaborates with social services, benefits counselors, external partners, and clinical and care teams. Additional duties include supporting staff training, keeping current on Medicaid policies, preparing patient education materials, responding to inquiries, and participating in quality improvement work. Travel is expected 5%–15% of the time. The schedule is 8:00 a.m.–4:30 p.m.

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, medical professionals, and other individuals.
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 a 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.
Help collect resource verifications and required documentation, submit accurate applications, 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 about renewals, collect documentation, provide guidance, and make home or center visits or deliver documents to DSS if needed.
Assist with 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, flag discrepancies, and notify patients of lapses, changes, or upcoming 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, eligibility rules, application processes, 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 related to Medicaid and other benefit programs.
Respond to inquiries from patients, caregivers, or external agencies about Medicaid or related benefits.
Perform other duties or projects related to patient financial advocacy, benefits optimization, or coverage continuity as assigned by the supervisor.