Medicaid Specialist

Salary: $65,000-$70,000, commensurate with experience

How To Apply

Applications are submitted online until the position is filled and/or the posting is closed. After reviewing this job announcement, please click on the link at the bottom of the page to apply online. A resume is required with the application. Further instructions on submission of documents are available in the online application. A resume may not be substituted for an application.

Minimum Requirements

• A Bachelor’s degree in Business Administration, Finance, Accounting, or a related discipline.
• Two (2) years of HealthCare-related business office experience (e.g., financials, accounting, billing, reconciliation, claims processing, etc.).
• One (1) year Medicaid eligibility and recertification processing experience, preferably in a Skilled Nursing Facility (SNF)/Long Term Care (LTC) or HealthCare setting.
• An equivalent combination of education and experience may be substituted.
  
  

It is the policy of Allegheny County that in order to receive a final offer of employment, candidates must successfully pass a background check, which includes verification of Allegheny County Real Estate Tax status, and drug/medical examinations as required for the position. The pre-employment drug screen must be completed within 48 hours of the acceptance of the conditional offer of employment.

Position Summary

The Medicaid Specialist works in the Kane Regional Center Business Office and is responsible for managing all aspects of the Medicaid eligibility and recertification process for Kane residents in accordance with Pennsylvania Department of Human Services (DHS) regulations. The work is of a specialized nature and ensures timely, accurate submissions of applications, verification of financial documentation, coordination with residents and families, and ongoing communication with the County Assistance Office (CAO). The Medicaid Specialist plays a key role in maintaining facility cash flow and reducing accounts receivable by securing and preserving Medicaid coverage. This role requires travel among two or more Kane Regional Center locations—Glen Hazel, McKeesport, Ross (Township), and Scott (Township).

Overview

Duties:

• Initiates, prepares, and submits Medicaid applications in accordance with Pennsylvania DHS/DOH guidelines.
• Conducts thorough reviews of resident financial documentation, including bank statements, insurance policies, income verification, real-estate property, and asset transfers.
• Identifies potential eligibility barriers such as excess resources, improper transfers, trusts, annuities, or gifting, and communicates required corrective actions to families/representatives.
• Tracks all application statuses to ensure timely CAO responses, verifications, and approvals.
• Oversees all Medicaid renewals/annual redeterminations as required by Department of Human Services (DHS).
• Monitors and addresses notices of incomplete information, requests for verification, or pending eligibility issues.
• Maintains up-to-date resident financial files, including Authorized Representatives forms, budgets, and liability amounts.
• Serves as a point of contact for residents, families, POAs, and guardians regarding Medicaid requirements and financial processes; explains complex eligibility rules in a clear, compassionate, and professional manner.
• Assists families in gathering required financial records and completing necessary paperwork.
• Works closely with the Business Office Manager, Admissions, Social Services, and Interdisciplinary Team to ensure smooth financial transitions; communicates with the Business Office Manager regarding spend-down amounts, patient liability, and effective dates of coverage.
• Tracks outstanding payer sources and supports reduction of private-pay aging through timely conversion to Medicaid.
• Follows all Pennsylvania Department of Human Services (DHS), Center for Medicare Services (CMS), and facility policies for Medicaid processing and resident financial rights.
• Performs other duties as assigned or requested.
  
  

Knowledge Of

Knowledge, Skills, and Abilities

• Center for Medicare Services (CMS) and Pennsylvania Medicaid rules and guidelines, community spouse guidelines, transfer penalties, and resource limits.
• PA Skilled Nursing Facility(SNF)/Long-Term Care(LTC) governance.
  
  

Skill In

• Microsoft Office Suite.
• Electronic Health Records (EHR)/billing systems and case-tracking tools.
  
  

Ability To

• Demonstrate attention to both broad and granular data review and data entry detail.
• Manage multiple cases and tasks simultaneously.
• Communicate effectively, both orally and in writing.
• Interpret financial documents and understand resource eligibility rules.
• Work independently and meet strict deadlines set forth by policy, process, or governing agencies (e.g., CMS).
• Perform occasional resident/family meetings on the units.
• Travel between all four Kane Regional Center locations.
  
  

Residency: Allegheny County within 1 year.

Veterans' Preference: Will be awarded to eligible candidates.

AN EQUAL OPPORTUNITY EMPLOYER - M/F/V/D

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