Medicaid Specialist Job at Blue Ridge Hospice (Winchester)

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.

Job Responsibility

Screen prospective PACE participants for Medicaid eligibility
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
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
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

Requirements

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

Nice to have

Associate’s or Bachelor’s degree in a related field
PACE, long‑term care Medicaid, managed care, or waiver experience
Experience with elderly, disabled, or vulnerable populations
Bilingual skills
Experience with state Medicaid portals and eligibility systems

What we offer

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

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Medicaid Specialist

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