Medicaid Specialist Position Available In Wilson, North Carolina

Medicaid Specialist August Healthcare Wilson, NC 27893 • Hybrid work ob

Title:

Medicaid Specialist –

Nursing Home Services Location:

North Carolina (regional coverage)

Job Type:

Full-time Department:

Business Office Reports To:

Vice President of Business Management Job Summary:

The Medicaid Specialist is responsible for managing and coordinating the Medicaid application and recertification processes for nursing home residents. This role ensures compliance with North Carolina Medicaid regulations, facilitates timely reimbursements, and works closely with residents, families, and government agencies to maintain accurate and complete records.

Key Responsibilities:

Assist residents and their families with completing and submitting Medicaid applications and renewals. Conduct interviews with residents or responsible parties to gather necessary documentation for Medicaid eligibility. Track and monitor Medicaid application statuses, deadlines, and redetermination dates. Work collaboratively with the Department of Social Services (DSS) and other state agencies to resolve application issues and expedite approvals. Maintain accurate resident financial records and documentation in compliance with HIPAA and facility policies. Educate residents and families on Medicaid requirements, eligibility criteria, and asset/resource documentation. Partner with admissions, social services, and billing departments to ensure timely placement and reimbursement processes. Respond to Medicaid-related inquiries from residents, family members, staff, and government agencies. Participate in audits, surveys, and inspections related to Medicaid documentation and procedures. Stay current on state Medicaid guidelines, changes in eligibility rules, and healthcare policies.

Qualifications:

High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Social Work, or related field preferred. Minimum of 2 years of experience in Medicaid eligibility processing, preferably in a long-term care or skilled nursing facility setting. Strong knowledge of North Carolina Medicaid regulations and nursing home reimbursement processes. Excellent communication, organizational, and problem-solving skills. Ability to manage multiple cases and deadlines in a fast-paced environment. Proficiency with Microsoft Office and electronic medical record (EMR) systems. Sensitivity and professionalism in dealing with elderly residents and their families.

Work Environment:

Primarily office-based within a nursing home or long-term care facility. Regular interaction with residents, families, and external agencies. May require occasional travel to county DSS offices or resident homes for document collection or interviews.