Regional Medicaid Specialist

Regional Medicaid Specialist

The Regional Medicaid Specialist manages Medicaid eligibility, applications, and pending accounts for residents across a multi-facility SNF organization. This role partners with facility teams, residents, families, and state agencies to ensure timely approvals, compliance, and reimbursement support.

Roles and responsibilities include managing Medicaid application processes for residents across multiple Skilled Nursing Facility locations, completing Medicaid applications, renewals, redeterminations, recertifications, and change reporting in accordance with assigned regions Medicaid regulations and payer timelines. Conducts resident and family interviews to gather eligibility information and explain Medicaid coverage, patient liability, spend-down requirements, and documentation needs in a clear and compassionate manner. Collects, reviews, validates, and maintains required eligibility documentation including income, assets, insurance, residency, trusts, transfers, and other supporting records. Monitors Medicaid pending accounts and aging reports to ensure timely submission, follow-up, approval, and reimbursement. Tracks application status and communicate directly with assigned regions Family and Social Services Administration (FSSA), county offices, caseworkers, and managed care organizations regarding pending applications and requests for information. Coordinates with Admissions, Social Services, BOMs, and Regional Teams to ensure accurate payer conversions, coverage verification, and financially appropriate admissions. Reviews eligibility determinations and assist with appeals, reconsiderations, or additional documentation requests when necessary. Supports timely assignment and verification of patient liability and communicate updates to facility business office teams and resident representatives. Maintains accurate, audit-ready documentation of applications, approvals, denials, renewals, correspondence, and case activity within designated systems. Audits resident accounts for compliance with Medicaid requirements, company policies, and reimbursement guidelines. Identifies and resolves Medicaid-related billing issues, discrepancies, and coverage gaps. Collaborates with facility billing and corporate revenue cycle teams to reduce pending Medicaid balances, minimize bad debt exposure, and improve cash collections. Provides education, training, and support to facility business office staff regarding assigned regions Medicaid processes, eligibility guidelines, and best practices. Stays current on state and federal Medicaid regulations affecting long-term care reimbursement and communicate relevant updates to operational teams. Ensures compliance with HIPAA, privacy regulations, and company confidentiality policies. Participates in special projects, audits, and process improvement initiatives related to Medicaid operations and revenue cycle performance. Other duties as assigned.

Qualifications: High School / GED, 5-8 years experience. Associates degree preferred.

Physical requirements include sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 20lbs. Must be able to maintain verbal and written communication with co-workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus.

Location: US-OH- North Ohio Division OH

Benefits include competitive salaries and weekly pay, 401(k) Company Match, mental health support program, student loan repayment and tuition reimbursement, health, vision, dental & life insurance kick in on the first of the month after your start date, first time homebuyers' program, HSA/FSA, and so much more!