Regional Medicaid Specialist

Position: Regional Medicaid Specialist - Skilled Nursing Facility

Are you looking to put your skills and the compassion you have for people to work, with an employer that values you and the work you do? If so, Vierra Communities is looking for you. If you are motivated, reliable and have a strong work ethic, we invite you to join our amazing team in providing our residents and patients with compassion and excellent care. We offer extremely generous and competitive pay and benefits and a positive work environment with a team that is committed to growth and providing excellent care.

Overview:

Vierra Communities are family-owned and operated and provide a truly unique health & rehabilitation experience. We have a close-knit staff that will do anything to create the best community and experience for our residents.

Vierra's Culture & Mission:

We have a positive, supportive and thriving culture that supports and encourages innovation, leadership, warmth and compassion and excellence. Our Mission: to advance and redefine healthcare.


Full-time Benefits:

• 7 Paid Major Holidays
• Generous PTO
• Medical, Dental and Vision
• Company Paid Life & AD&D Insurance & LTD
• Voluntary Life Insurance
• 401(k) immediate enrollment with match
• Tuition Reimbursement (up to $2,500 annually)
• Referral Bonus Program (up to $1,000)

Required Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or Social Work
• LTC/SNF Experience: Minimum of 3 to 5 years of direct experience managing the long - term care Medicaid application process inside an SNF.
• Multi-Facility Management: Demonstrated background in a regional, corporate, or consulting capacity overseeing multiple business office managers (BOMs).
• Revenue Cycle Management: Proven success handling accounts receivable, medicalbilling, collections,and patient liability (share of cost) tracking

Major Duties and Responsibilities

Medicaid Program Support

• 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. Provider & Community Relations
• 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.

Insurance & Billing Coordination

• 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.

Communication & Customer Service

• 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

Additional Requirements:

• Must be able to perform the physical requirements of the position

Vierra Communities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements Vierra Communities complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.