Medicaid Specialist

MEDICAID SPECIALIST.

Location: Sanford Treatment Center.

Department: Clinical/Administrative Services.

Reports To: Program Director/Regional Director.

Employment Status: Full-Time 5:30am to 1:00pm.

Position Summary:

The Medicaid Specialist provides case management and administrative support to patients related to Medicaid eligibility, required reporting, workforce participation requirements, and supporting documentation. The position assists patients in understanding reporting responsibilities, identifying documentation needed to demonstrate compliance, accessing appropriate workforce and community resources, and completing required follow-up activities.

The Medicaid Specialist works directly with patients and members of the treatment team to identify barriers that may interfere with a patient's ability to meet Medicaid requirements and assists the patient with accessing available resources and maintaining appropriate documentation.

Essential Duties and Responsibilities:

• Verify Medicaid eligibility and coverage information through NCTracks and other applicable Medicaid resources.
• Educate patients regarding applicable Medicaid reporting responsibilities and workforce participation requirements.
• Assist patients with understanding required reporting timeframes, documentation requirements, and available methods for submitting information.
• Assist patients with gathering and organizing documentation needed to support reported workforce activities or other qualifying activities.
• Assist patients with reporting employment, work hours, education, training, volunteer activities, or other qualifying activities, when applicable.
• Assist patients with identifying and documenting circumstances that may qualify for an exemption or exception from applicable workforce requirements.
• Provide patients with information regarding employment, education, vocational training, workforce development, and community resources.
• Follow up with patients regarding outstanding documentation, reporting requirements, referrals, and identified needs.
• Maintain accurate documentation of patient contacts, assistance provided, referrals, reported barriers, supporting documentation received, and follow-up activities.
• Document patient-reported workforce participation information in the appropriate organizational record according to established procedures.
• Maintain copies of supporting documentation when permitted and required by organizational policy.
• Track upcoming reporting requirements and assist patients with completing required follow-up within established timeframes.
• Communicate identified Medicaid concerns or potential interruptions in coverage to the patient and appropriate members of the treatment team.
• Assist patients who report changes in employment, work hours, education, qualifying activities, or other circumstances that may affect Medicaid requirements.
• Maintain appropriate professional boundaries and provide assistance within the scope of the Medicaid Specialist role.
• Participate in staff meetings, treatment team activities, training, and quality improvement activities as assigned.
• Maintain confidentiality in accordance with HIPAA, 42 CFR Part 2, applicable Medicaid requirements, and organizational policies.
• Perform other related duties as assigned.

Minimum Qualifications:

• High school diploma or equivalent required.
• Associate degree in human services, social work, healthcare administration, behavioral health, or a related field preferred.
• Experience with Medicaid, case management, care coordination, workforce services, social services, or behavioral healthcare preferred.
• Familiarity with North Carolina Medicaid and NCTracks preferred.
• Experience working with individuals receiving substance use disorder treatment preferred.
• Strong organizational, communication, documentation, and follow-up skills.
• Ability to maintain confidentiality and work effectively with patients, clinical staff, governmental agencies, and community organizations.