Medicaid Coordinator

Job Description

Job Description

Key Responsibilities

1. Medicaid Application & Eligibility

• Completes Medicaid applications with assistance of residents and families
• Gather required financial and legal documentation (bank records, assets, income)
• Submit applications and track approval status
• Monitor eligibility timelines and renewal deadlines
• Complete Recertification and Conversion application
• Complete Medicare applications for new residents 65 and older
• Disenroll from Managed Medicaid when applicable

1a.      Residents Income /Residents Funds

·        Complete address change for all income on all residents

·        Maintain RFMS accounts for all residents

·        Issue checks from RFMS account when necessary

·        Update RFMS accounts with any credit and debits weekly

·        Prepare resident statements for distribution quarterly

2. Financial Case Management

• Review residents’ financial status to ensure compliance with Medicaid rules (financial screening for potential new patients)
• Help structure spend-down strategies (within legal guidelines)
• Track patient liability (how much the resident must contribute toward care)

3. Communication & Liaison Work

• Act as the main point of contact between:
• Residents/families
• State Medicaid offices

·         Social workers and admissions staff

• Respond to Medicaid inquiries, requests for additional documentation, or audits
• And any other tasks within your scope of practice that is requested of you by administration

4. Compliance & Documentation

• Maintain accurate and organized resident financial records
• Ensure compliance with federal and state Medicaid regulations
• Prepare for audits and ensure files are audit-ready

5. Billing & Reimbursement Support

• Coordinate with billing department to ensure proper Medicaid reimbursement
• Resolve eligibility or coverage issues that affect payment

Required Skills & Qualifications

• Knowledge of Medicaid rules and long-term care eligibility requirements
• Strong attention to detail and organization
• Ability to interpret financial documents
• Excellent communication and interpersonal skills
• Experience with healthcare administration, social services, or finance preferred

Typical Education & Experience

• Associate’s or Bachelor’s degree (Healthcare Administration, Social Work, Finance, or related field)
• Prior experience in:
• Nursing home administration
• Medicaid processing
• Case management or admissions

Work Environment

• Typically based in a nursing home or long-term care facility
• Works closely with admissions, billing, and social services teams
• May handle a high caseload of residents with strict deadlines