Medicaid Eligibility Specialist

The Medicaid Eligibility Specialist assists clients with the Medicaid application and approval process by providing guidance, gathering required documentation, completing applications, and monitoring application status. This position serves as a resource for clients, helping them navigate eligibility requirements and ensuring timely submission of necessary information to support Medicaid approvals.

Education:  

• High School Diploma or equivalent 

Work Experiences:  

• At least 2 years of experience in a healthcare setting. 
  
  

Responsibilities: 

• Meet with clients to explain Medicaid eligibility requirements and application processes.  

• Assist clients in completing Medicaid applications accurately and thoroughly.  

• Collect, review, and organize required documentation needed to support Medicaid eligibility determinations.  

• Follow up with clients regarding missing information or documentation.  

• Track application status and assist clients with responding to requests for additional information.  

• Maintain accurate and up-to-date client records in accordance with organizational policies and confidentiality requirements.  

• Communicate with government agencies, healthcare providers, and other relevant parties as needed to support the application process.  

• Educate clients on Medicaid benefits, coverage options, and renewal requirements.  

• Assist clients with Medicaid redeterminations, renewals, and related eligibility matters.  

• Stay informed of changes to Medicaid guidelines, regulations, and processes.  

• Provide exceptional customer service while maintaining professionalism and compassion when working with clients and families.  

• Participate in team meetings, training, and other organizational activities as assigned. 

• Promote a client-centered culture across all programs and departments. 

• Provide actionable insights and recommendations for leadership. 

• Partner with clinical and operational teams to improve client experience. 

• Promote healthy communication with community stakeholders, intra and interdepartmental relationships. 

• Ensure consistency in service delivery standards across locations and service lines 

• including but not limited to the Department of Mental Health-Mental Health Program and Core Rule certification standards, CARF accreditation standards, and Center and Program processes, policies, and procedures.  

• Perform specific administrative tasks as determined by the executive team. 

• Perform all other duties as assigned.  

Physical Requirements:  

• Normal office environment.  

• Typical demands include prolonged sitting, frequent standing, bending, stooping, and occasional lifting.  

• Requires normal range of hearing and manual dexterity sufficient to operate keyboard, telephone, photocopier, calculator, and other office equipment as needed.  

• Requires the ability to remain calm during stressful events, to occasionally work irregular hours, and work with exasperated individuals.  

• Occasional lifting to 50 pounds 

• Occasional travel required  

• TB test upon hire.