Medicaid Enrollment Specialist

Medicaid Enrollment Specialist Newark, New Jersey Employment Type: Full-Time The Medicaid Enrollment Specialist is responsible for successfully enrolling prospective participants in Medicaid, with a focus on Medi-Cal enrollment. This position is part of the Marketing, Outreach, and Enrollment (MOE) team. The specialist will work directly with prospective participants, county Department of Public and Social Services (DPSS) representatives, and internal enrollment teams to ensure applications are complete, submitted on time, and actively followed through the approval process. The role requires strong knowledge of Medicaid enrollment rules and complex case management, including share of cost, spousal impoverishment protections, and appeals processes. Key Responsibilities 1. Medicaid Application and Enrollment Management Gather all necessary documentation to prepare complete Medicaid enrollment applications. Create and submit Medicaid applications for prospective participants. Diligently pursue and follow up on submitted applications to support successful enrollment. Monitor pending applications and coordinate with relevant parties to address missing information or delays. Manage Medicaid enrollment cases through the application and determination process. Support and appeal Medicaid enrollment denials when necessary. 2. Participant Documentation and Home Visits Visit seniors' homes as needed to gather documentation required for complete Medicaid applications. Work directly with prospective participants to explain documentation requirements. Coordinate collection of necessary supporting records and information. Ensure applications are complete and submitted within applicable deadlines. 3. County DPSS Coordination and Compliance Maintain strong working relationships with county Department of Public and Social Services (DPSS) representatives. Coordinate with county offices to ensure a seamless enrollment workflow. Follow up on applications and outstanding documentation. Adhere to enrollment deadlines and applicable policies. Ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) guidelines and policies. Follow applicable marketing guidelines and Medicaid denial policies. 4. Medicaid Enrollment Events and Community Outreach Create and conduct Medicaid enrollment events to attract prospective participants. Conduct weekly enrollment events at each WelbeHealth center within the assigned territory. Organize monthly enrollment events at: Senior housing communities. Hospitals. Senior centers. Churches. Conduct monthly virtual Medicaid enrollment sessions. Provide backup and support to Outreach and Enrollment functions as assigned. 5. Complex Medicaid Case Management Demonstrate in-depth knowledge of Medicaid rules, processes, practices, and enrollment options. Support prospective participants with complex Medicaid enrollment matters, including: Share of cost. Spousal impoverishment protections. Medicaid enrollment options. Application denials and appeals processes. Explain applicable enrollment requirements and help prospective participants navigate complex cases. Required Qualifications Minimum of three (3) years of experience working directly with county DPSS submitting, managing, and appealing Medicaid enrollments. Demonstrated knowledge and experience with complex Medicaid enrollment case management. Strong knowledge of Medicaid enrollment rules, processes, and practices. Experience managing Medicaid application submissions, follow-ups, and appeals. Ability to maintain effective working relationships with county DPSS representatives. Strong communication, organization, documentation, and follow-up skills. Critical Requirement: Medicaid knowledge is a must. General healthcare administration or insurance verification experience alone does not establish the required direct Medicaid enrollment experience. Preferred Qualifications Bachelor's degree in a relevant field preferred. An additional five (5) years of relevant Medicaid enrollment experience may be substituted for the preferred bachelor's degree. Spanish-English bilingual communication skills strongly preferred. Experience working directly with senior participants and individuals navigating complex healthcare enrollment requirements. Experience organizing community-based and virtual enrollment events. Education Requirements Minimum Education Listed: High School Diploma or Equivalent. Preferred Education: Bachelor's degree in a relevant field. Experience Substitution: An additional five years of relevant Medicaid enrollment experience may be substituted for the preferred bachelor's degree. Ideal Candidate Profile The ideal candidate will have hands-on experience working directly with county DPSS offices and managing Medicaid enrollment applications from documentation collection and submission through follow-up, denial management, and appeals. The candidate should understand complex Medicaid enrollment matters, particularly share of cost and spousal impoverishment protections. Strong communication and coordination skills are important, as the specialist will interact with senior participants, county agencies, and internal enrollment teams. Spanish-English bilingual skills are strongly preferred. The candidate must be comfortable with occasional travel for home visits and community enrollment events. #J-18808-Ljbffr Veracity Ventures Inc.