Customer Service - Medicaid

We are seeking a compassionate, organized, and detail-oriented Medicaid Eligibility & Long-Term Care Services Specialist to assist older adults and individuals in navigating the Medicaid eligibility and application process.

This position serves as an important resource for individuals, families, caregivers, healthcare professionals, and community organizations by providing screening, education, application assistance, follow-up, and advocacy throughout the Medicaid eligibility process.

The ideal candidate will have excellent communication skills, strong attention to detail, and the ability to work effectively with individuals who may require assistance navigating complex benefit programs.

Essential Responsibilities

• Receive referrals from the Elder Helpline and other community resources for intake and screening based on assignments from the LTCS Coordinator and/or Manager.
• Evaluate individual needs and connect consumers who require community-based assistance with appropriate Elder Helpline resources.
• Conduct initial and comprehensive screenings to determine potential eligibility for Medicaid-related programs using established screening tools and procedures.
• Provide timely, professional, and consumer-focused assistance throughout the Medicaid eligibility application and review process.
• Verify current Medicaid eligibility and explain applicable program requirements, eligibility guidelines, and application procedures to prospective applicants.
• Conduct comprehensive screenings for individuals identified on the Assessed Priority Consumer List (APCL).
• Enter and maintain accurate consumer assessment information in CIRTS (Client Information and Registration Tracking System).
• Update enrollment and termination information in CIRTS to maintain accurate APCL records.
• Prepare, organize, and distribute required forms and documentation necessary for Medicaid eligibility determinations.
• Collect and review information needed to support eligibility determinations, including financial resources and third-party liability information.
• Assist individuals, families, and caregivers in obtaining required documentation and completing Medicaid applications.
• Provide application assistance in the individual's home when appropriate and necessary.
• Serve as a secondary support resource to family members and care providers assisting individuals with Medicaid applications.
• Coordinate referrals to local Department of Children and Families (DCF)/ACCESS representatives for formal Medicaid applications.
• Communicate and coordinate with DCF/ACCESS personnel regarding eligibility questions and issues affecting current or prospective Medicaid recipients.
• Assist Medicaid Waiver candidates in obtaining the required Physical Referral Form (Form 3008) and coordinate with CARES (Comprehensive Assessment and Review for Long-Term Care Services) staff regarding functional eligibility.
• Maintain accurate tracking records related to Medicaid eligibility determinations, applications, and outcomes.
• Monitor Medicaid applications throughout the eligibility determination process and follow up as needed.
• Contact individuals on the APCL to update information, reassess circumstances, and identify potential Medicaid eligibility.
• Participate in coordination meetings with DCF, CARES, and other community partners to improve communication and streamline the eligibility determination process.
• Advocate for consumers by working with DCF/ACCESS, CARES, and other agencies to identify and resolve eligibility issues in a timely manner.
• Conduct consistent community outreach to increase awareness of Medicaid programs, services, eligibility requirements, and available resources.
• Develop and distribute educational materials that help consumers understand available Medicaid programs and how to access benefits.
• Establish and maintain professional relationships with healthcare providers, hospital discharge planners, nursing home social workers, care providers, and other community professionals to increase referrals and awareness of Medicaid resources.
• Provide education and training to ADRC access points and community partners regarding Medicaid programs and available resources.
• Provide Medicaid-related assistance and information during emergency or disaster situations when assigned.
• Perform additional Medicaid, long-term care, and related duties as assigned.

Minimum Education & Experience

Candidates must meet one of the following requirements:

• Bachelor's degree from an accredited institution; OR
• Associate's degree plus two (2) years of relevant experience; OR
• High school diploma/GED plus four (4) years of relevant experience.

Successful completion of all applicable background screening is required.

Exceptions to the minimum qualifications require approval from the President and CEO.

Fun and stable environment with excellent training