Medicaid Pending Specialist

Job Description

This person will spend most of their time developing a Medicaid pending process, tracking Medicaid pending aging’s.  This role will include educating and training the office managers on Medicaid pending best practices to ensure positive outcomes with Bad Debt, DSO and Cash Collections. The Medicaid Pending Resource will conduct weekly Medicaid pending aging reviews to look for patterns and trends to see where training is needed.   Will be well-versed in all aspects of Florida Medicaid including, Medicaid applications, asset limits, and local Medicaid office case workers.   

Key Responsibilities

• Track and manage a caseload of Medicaid Pending residents from admission through Medicaid approval

• Complete, submit, and follow up on Medicaid applications with state/county eligibility offices

• Coordinate with residents, families, and responsible parties to gather required documentation (financial, medical, legal)

• Communicate regularly with facility Business Office Managers, Admissions, and Social Services to resolve outstanding eligibility issues

• Monitor and report on aging pending accounts; escalate stalled cases to reduce time-to-approval

• Maintain accurate, up-to-date records in the resident management/billing system (e.g., PointClickCare, Matrixcare)

• Ensure compliance with state Medicaid regulations and PACS policies

• Partner with Medicaid caseworkers and eligibility agencies to expedite determinations

• Assist in spend-down documentation, resource assessments, and appeals when applications are denied

• Proficient in Excel and PCC

Qualifications

The Medicaid Pending Resource should have a minimum of four years’ experience and proven success in a Skilled Nursing Facility.  

• Effective in business office operations

• Working knowledge of Medicaid eligibility requirements (state-specific knowledge a plus)

• Proven positive outcomes in cash collections, bad debt and DSO

• Experience with EHR/billing systems (PointClickCare preferred)

• Strong organizational skills with ability to manage a high-volume caseload

• Ability to multi-task in different programs and be able to assist multiple facilities at once

• Excellent communication skills for interfacing with families, state agencies, and internal stakeholders

• High school diploma required; associate's or bachelor's degree preferred

• Must be flexible and willing to travel to different facilities located in Florida

• Leadership abilities that promote a positive work environment while teaching and training

• Effective time management, organizational skills, and detail-oriented

• Prior experience in a multi-facility or corporate long-term care environment

• Familiarity with Medicaid spend-down, trusts, and asset transfer rules

• 2+ years of experience with Medicaid eligibility, long-term care billing, or skilled nursing preferred

The Candidate

The ideal candidate will be hard-working, detail oriented, team-orientated, service-minded and proactive. Someone who takes pride in providing a high-quality work product and seeks continuous improvement.

We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.