Medicaid Specialist

Job Details: Job Location: GREEN - UNIONTOWN, OH 44685, Salary Range: $43,400.00 - $52,500.00 Salary/year,

Function(s):

The Medicaid Specialist is responsible for ensuring accurate, timely and compliant Medicaid eligibility, enrollment, redetermination and waiver operations across multiple state and managed care systems.

JOB RESPONSIBILITIES:

• Provide enrollee-related support to Care Management and Assessment Departments and staff
• Process and resolve daily alerts identifying eligibility changes, share of cost updates, plan flips and system discrepancies across Ohio Benefits, Provider Network Management, Master List, PIMS and MCO portals.
• Complete chart assignments and closures with full documentation and cross-system verification.
• Manage reinstatements of Medicaid eligibility, ensuring timely correction of eligibility interruptions to prevent service gaps.
• Perform Share of Cost processing daily, ensuring accuracy and compliance with waiver requirements.
• Process disenrollments across multiple MCO’s including PASSPORT/Assisted Living, MyCare CareSource, Molina, Anthem and Buckeye.
• Complete mailing of State Hearing rights.
• Conduct continuous monitoring of eligibility changes across Ohio Benefits, PNM, master list, PIMS and MCO systems, identifying discrepancies and initiating corrective action.
• Maintain and update tracking logs for state-funded cases, closures, reinstatements, Assisted Living enrollments/disenrollments, share of cost, and other eligibility actions.
• Perform accurate and reconciled monthly and quarterly reporting, including:
  • CareSource Vendor report
  • CareSource billing
  • MAGI report
  • Medicaid Renewal Reports
  • PIMS Waiver Enrollment Report
  • Transitions/Flip reports
  • Suspension Report
  • Molina Audit Report
  • Any evolving reports that are required as Next Generation
• Serve as primary liaison to County JFS, Managed Care Organizations, Ohio Department of Medicaid and Ohio Department of Aging regarding eligibility, Share of Cost and waiver enrollment issues.
• Initiate and track escalations for eligibility errors, system mismatches, and billing discrepancies.
• Coordinate with Care Managers/WSCs to communicate eligibility changes, plan updates and SOC adjustments.
• Advocate for timely Medicaid approvals and resolve conflicts through direct communication with state and county partners.
• Navigate and maintain proficiency in multiple state and program systems, including OB (Ohio Benefits), PNM (Provider Network Management), Master List, PIMS, MCO portals (MyCare CareSource, Moline, Anthem and Buckeye).
• Perform data entry and documentation across all systems.
• Upload required documentation into agency and program-specific systems.

Qualifications:

Required:

• 1 year of relevant experience.
• High School diploma

Preferred:

• Intermediate experience with Microsoft Office programs including Excel, Outlook, Word and Access database use.
• Previous data entry experience
• Previous insurance billing experience
• Some college education