Medicaid Benefits Coordinator

Who We Are

Prestige Healthcare Resources, Inc. (PHRI) is a mission-driven behavioral healthcare organization committed to delivering high-quality, person-centered services across the District of Columbia. We specialize in supporting individuals with behavioral health needs by ensuring seamless access to care, stability, and community-based support.

A critical part of this mission is ensuring Consumers maintain active Medicaid coverage so they can receive consistent, uninterrupted services. As we expand our administrative and consumer support functions, we are seeking a dedicated Medicaid Benefits Coordinator to strengthen our eligibility, enrollment, and coverage management processes.

What You’ll Do

As the Medicaid Benefits Coordinator, you will help Consumers apply for, secure, and maintain Medicaid benefits—ensuring timely access to care and preventing lapses in coverage. Your work directly impacts service continuity, billing accuracy, and Consumer satisfaction.

Your responsibilities include:

Medicaid Application & Enrollment

• Assist Consumers with completing new Medicaid applications and renewals.

• Guide Consumers through documentation requirements and submission steps.

• Educate Consumers on eligibility rules, MCO choices, renewal cycles, and timelines.

• Communicate with DHS, Medicaid offices, and MCO representatives as needed.

Coverage Maintenance & Case Management

• Monitor Medicaid status and track upcoming expirations or risks of termination.

• Proactively contact Consumers to address pending renewals or missing documents.

• Resolve issues such as verification delays or eligibility discrepancies.

• Confirm application statuses, reinstatements, or corrections with DHS/MCOs.

Documentation & EHR Management

• Maintain accurate Medicaid records within the EHR.

• Document all interactions and outcomes according to DC MHRS and HIPAA standards.

• Track approvals, lapses, reinstatements, and MCO enrollment changes.

Consumer Communication & Support

• Provide clear, compassionate, step-by-step guidance throughout the Medicaid process.

• Assist Consumers facing barriers such as limited documentation or difficulty navigating systems.

Coordination & Collaboration

• Work with intake, billing, clinical, and administrative teams.

• Notify staff when Medicaid issues impact service eligibility or billing.

• Partner with billing teams to reduce denials related to lapses or incorrect data.

Problem Resolution & Follow-Up

• Investigate and resolve coverage discrepancies or unexpected terminations.

• Communicate with DHS, MCOs, and partner agencies to troubleshoot complex cases.

• Track unresolved issues and provide consistent follow-up until resolved.

Compliance, Reporting & Quality Assurance

• Follow all DC Medicaid, MCO, DHS, and agency guidelines.

• Generate reports on Medicaid status, renewals, and unresolved issues.

• Support audits through accurate, compliant documentation.

• Keep staff informed of policy changes.

Process Improvement

• Recommend workflow enhancements and participate in Medicaid-related trainings.

What You’ll Bring

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.

• 1–2 years of experience in Medicaid eligibility, insurance navigation, benefits coordination, or case management.

• Strong familiarity with DC Medicaid, MCO processes, DHS requirements, and public benefits systems (strongly preferred).

• Experience with EHR systems and Microsoft Office Suite.

• Excellent organizational skills, accuracy, and attention to detail.

• Strong communication, customer service, and problem-solving skills.

• Ability to maintain confidentiality, professionalism, and Consumer trust.

• Ability to work independently and collaboratively within multidisciplinary teams.

Why Prestige

• Mission-driven work: Your efforts ensure Consumers have uninterrupted access to essential behavioral health services.

• Impact you can see: Preventing Medicaid lapses directly improves service delivery, billing accuracy, and client outcomes.

• Supportive team culture: Work collaboratively with intake, billing, and clinical teams who value communication and partnership.

• Professional development: Grow your expertise in Medicaid systems, managed care processes, and agency operations.

• Community-focused organization: Prestige is committed to empowering individuals, families, and communities through accessible, quality behavioral healthcare.
  
  
  

Core Competencies

1. Medicaid Expertise

Understands Medicaid eligibility, renewals, documentation requirements, and MCO processes to ensure continuous Consumer coverage.

2. Accuracy & Attention to Detail

Maintains precise documentation, data entry, and case tracking to prevent coverage lapses and billing errors.

3. Consumer Advocacy

Provides compassionate, clear guidance to Consumers, helping them overcome barriers and navigate complex eligibility processes.

4. Problem Solving

Identifies issues quickly, troubleshoots with DHS/MCOs, and follows cases through to full resolution.

5. Communication Skills

Communicates effectively with Consumers, internal teams, and external agencies; conveys information in a clear, supportive manner.

6. Collaboration

Works seamlessly with intake, billing, clinical, and administrative teams to ensure service continuity and reimbursement accuracy.

7. Compliance & Confidentiality

Follows all HIPAA, DC MHRS, Medicaid, and agency regulations while maintaining strict confidentiality.

8. Organization & Time Management

Manages multiple cases, deadlines, and follow-up tasks efficiently in a fast-paced environment.

AAP/EEO STATEMENT

It is the policy of Prestige Healthcare Resources, Inc. to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Prestige Healthcare Resources, Inc. will provide reasonable accommodations for qualified individuals with disabilities.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.