Medicaid Specialist

Job Description

Job Description

Medicaid Specialist – Blue Ridge Care Services

Your expertise can open doors to care.
Your guidance can change the journey for aging adults and their families.

At Blue Ridge Care, our mission is simple: delivering extraordinary care to improve life’s journey. As a not‑for‑profit, mission‑driven healthcare organization, we support older adults and those facing serious illness through integrated services—including hospice, serious illness care, PACE, grief support, and community thrift shops.

Our PACE (Program of All-Inclusive Care for the Elderly) team ensures that participants receive comprehensive, coordinated care that honors dignity, choice, and quality of life. The Medicaid Specialist plays a pivotal role in making that possible.

We’re looking for a compassionate, detail‑driven Medicaid Specialist to guide participants through Medicaid eligibility, enrollment, and continued coverage. In this role, you’ll ensure each participant has timely access to services, maintain strict regulatory compliance, and collaborate closely with our interdisciplinary teams.

You’ll serve as a trusted resource for participants, caregivers, and internal partners, helping older adults navigate complex Medicaid processes with clarity and confidence.

• Screen prospective PACE participants for Medicaid eligibility (full, partial, or spend‑down).

• Prepare, submit, and track Medicaid applications, renewals, and recertifications.

• Coordinate eligibility determinations with state/local DSS or Medicaid agencies.

• Monitor application timelines to ensure enrollment compliance and prevent coverage gaps.

• Maintain active oversight of participant eligibility, renewals, and benefit changes.

• Resolve Medicaid issues, denials, gaps, or discrepancies.

• Document eligibility status accurately in enrollment and EHR systems.

• Follow CMS PACE regulations, state Medicaid policies, and internal procedures.

• Stay current on Medicaid eligibility rules, LTC Medicaid, waiver programs, and PACE-specific regulations.

• Support audits, readiness reviews, and compliance monitoring with complete, accurate records.

• Educate participants and caregivers about Medicaid benefits, renewals, and requirements.

• Communicate clearly and compassionately with diverse elderly populations and families.

• Assist in obtaining required documentation (income, assets, residency, citizenship, etc.).

• Partner with Enrollment, Finance, Social Work, and the Interdisciplinary Team (IDT).

• Communicate eligibility updates that may impact services or capitation.

• Support process improvements and participant‑centered enrollment growth initiatives.

• Track application metrics, approval timelines, and payer changes.

• Prepare reports on trends, status updates, and compliance findings.

• Maintain accurate files in compliance with HIPAA and organizational policies.

• High School diploma or GED required.

• Associate’s or Bachelor’s degree in a related field preferred.

• Minimum 2 years of Medicaid eligibility, enrollment, or benefits coordination experience.

• PACE, long‑term care Medicaid, managed care, or waiver experience strongly preferred.

• Experience with elderly, disabled, or vulnerable populations is helpful.

• Strong knowledge of Medicaid rules and application processes.

• Familiarity with CMS and state Medicaid regulations for PACE.

• Excellent organization, communication, and time‑management skills.

• Accuracy and attention to detail when managing multiple cases.

• Proficiency in Microsoft Office and enrollment/EHR systems.

• Knowledge of Medicare, dual‑eligible, and spend‑down processes.

• Bilingual skills a plus based on community needs.

• Experience with state Medicaid portals and eligibility systems.

• Ability to sit, stand, walk, and occasionally lift up to 25 pounds.

• Effective hearing and vision (with or without accommodation).

• Ability to document, communicate clearly, and engage with participants and families.

• Ability to work under stressful conditions, meet appointments, and navigate challenging family dynamics.

• Occasional travel to state agencies, participant homes, or community events.

At Blue Ridge Care, taking care of people starts with taking care of our team. We offer a supportive, mission-driven environment where every role contributes to improving lives—and your work truly matters.

• Competitive Pay

• PTO & Paid Volunteer Time

• Comprehensive Health Benefits

• Tuition Reimbursement & Scholarships

• Peer Support & Mentorship

• 30% Thrift Shop Discount

• Growth Opportunities aligned with our Blue Ridge Care 2030 Strategic Plan

Here, you’re not just navigating eligibility—you’re empowering independence, dignity, and compassionate care for our community.

Blue Ridge Care is a non-profit, equal opportunity employer. We celebrate diversity and foster an inclusive environment for all.