Regional Medicaid Specialist

Vierra Communities•Arlington, VA

About The Position

Vierra Communities is seeking a motivated, reliable, and strong work ethic Regional Medicaid Specialist to join their team. This role involves providing compassion and excellent care to residents and patients within a Rehab and Nursing facility. The company offers generous pay and benefits, a positive work environment, and a team committed to growth and excellent care. Vierra Communities is a family-owned and operated Rehab and Nursing facility that provides a unique health & rehabilitation experience with a close-knit staff.

Requirements

Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or Social Work.
Minimum of 3 to 5 years of direct experience managing the long-term care Medicaid application process inside an SNF.
Demonstrated background in a regional, corporate, or consulting capacity overseeing multiple business office managers (BOMs).
Proven success handling accounts receivable, medical billing, collections, and patient liability (share of cost) tracking.
Must be able to perform the physical requirements of the position.

Responsibilities

Serve as a regional expert on assigned state Medicaid policies, procedures, and eligibility requirements.
Monitor pending Medicaid applications and follow up with facility staff and the local and state Medicaid agencies.
Assist staff and residents with Medicaid enrollment, renewals, and benefit questions.
Track eligibility determination dates and maintain accurate records of approvals, denials, and renewals.
Monitor changes to state Medicaid regulations and communicate updates to stakeholders.
Support managed care operations and Medicaid waiver programs.
Build and maintain relationships with healthcare providers, community organizations, and state agencies.
Conduct outreach and training sessions regarding Medicaid processes and compliance standards.
Assist providers with credentialing, billing questions, prior authorizations, and claims resolution.
Work closely with the billing department to ensure accurate payer source information.
Coordinate benefits between Medicare, Medicaid, managed care plans, hospice, and private insurance.
Assist with resolving claim denials due to eligibility issues.
Ensure proper documentation supports reimbursement claims.
Communicate payer changes promptly to appropriate departments.
Serve as a liaison between residents, families, facility staff, and Medicaid agencies.
Explain Medicaid processes and requirements in a professional and compassionate manner.
Respond promptly to inquiries regarding Medicaid status and coverage.
Collaborate with Business Office, admissions, social services, therapy, and nursing departments to support resident care and financial planning.