Senior Medicaid Supervisor

About Us: At POD Health, we improve patient outcomes by combining technology with personalized, accessible care. Our integrated services—Telehealth, Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Initiatives (BHI)—ensure patients receive the support they need, wherever they are. Through Telehealth and RPM, patients gain real‑time access to care, empowering them to manage their health proactively and avoid unnecessary hospital visits. Our CCM programs provide tailored support for individuals with chronic conditions, ensuring continuity between office visits. Meanwhile, our Community Health Initiatives address health disparities and expand access to underserved populations. At POD Health, we are committed to making healthcare personal, proactive, and accessible for all.
Position Summary: The Senior Medicaid Supervisor is responsible for overseeing all aspects of Medicaid eligibility, enrollment, and recertification processes. This role serves as a subject matter expert in Medicaid programs, ensuring compliance with federal and state regulations while guiding and developing a team to effectively secure and maintain coverage for clients. The Supervisor plays a critical role in preventing coverage gaps, resolving complex cases, and improving operational workflows.
Key Responsibilities:

• Team Management & Leadership: Lead, supervise, and develop a team of Medicaid Specialists, providing training, coaching, mentorship, and performance management to ensure high-quality service delivery and productivity


• Operational Oversight: 
  
  
  
  • Serve as the primary subject matter expert on Medicaid eligibility pathways, including income-based, disability-based, and long-term care/home care programs.
  
  
  • Manage the collection, preparation, review, and submission of Medicaid applications, forms, renewals, recertifications, and all required supporting documentation for clients and participants.
  
  
  • Conduct regular audits of cases, claims, and documentation to ensure accuracy, compliance, timely follow-up, and adherence to organizational standards.
  
  
  • Develop, implement, and refine workflows, internal controls, and best practices to improve efficiency, reduce application errors, minimize denials, and strengthen team performance.
  
  
  
  


• Eligibility Support
  
  
  
  • Monitor client eligibility factors such as income thresholds, asset limits, household composition, and life changes that may impact Medicaid status.
  
  
  • Handle complex cases, including, but not limited to:
    
    
    
    • Spend-down and income eligibility issues
    
    
    • Pooled processes and coordination  
    
    
    • Code removals and case corrections
    
    
    • Coverage reinstatement and gap prevention
    
    
    
    
  
  
  
  


• Technical Operations
  
  
  
  • Monitor participant eligibility in real time using systems such as ePACES and other Medicaid platforms to verify active coverage prior to service delivery.
  
  
  • Utilize claim status inquiry tools to monitor adjudicated claims, resolve denials, reconcile discrepancies, and improve reimbursement outcomes.
  
  
  
  


• Claims Management
  
  
  
  • Oversee claims operations, including creation, batching, and submission of HIPAA-compliant professional claims through eMedNY or other approved billing systems.
  
  
  
  


• Prior Approvals
  
  
  
  • Initiate, track, and manage Prior Approval/DVS requests and other authorizations for specialized or covered services to maximize revenue and ensure regulatory compliance.
  
  
  
  


• Policy and Regulatory Compliance
  
  
  
  • Oversee all Medicaid eligibility, enrollment, renewal, and recertification processes to ensure timely submission, uninterrupted coverage, and compliance with all federal, state, and local regulations.
  
  
  • Act as liaison with government agencies including HRA, Medicaid offices, managed care plans, and other regulatory bodies to resolve issues and expedite case processing.
  
  
  • Stay current on Medicaid policy updates, procedural changes, immigration-related eligibility rules, and reimbursement requirements; communicate changes to staff and leadership.
  
  
  
  


• Reporting
  
  
  
  • Maintain detailed records, dashboards, and reports on team productivity, case outcomes, claims activity, and operational performance metrics.
  
  
  
  


• Inter-departmental Coordination    
  
  
  
  • Collaborate with leadership and cross-functional departments to support organizational goals, improve client experience, and optimize Medicaid operations.
  
  
  
  

Qualifications:

• Experience: 5+ years of direct experience in New York Medicaid eligibility, billing, or case management.


• System Expertise: Expert-level knowledge of ePACES, including Eligibility Requests, Claim Status, and Prior Approval functions.


• Compliance: Deep familiarity with NYC and NYS guidelines, including the Welfare Management System (WMS) and eMedNY requirements.


• Communication: Ability to act as an Authorized Representative for participants and clearly explain complex Medicaid regulations to patients and families.