Job Description
The PACE Benefit Specialist is responsible for engaging, educating, and supporting patients and community members throughout the entire Medicaid lifecycle—from initial application to annual renewals, eligibility checks, and transitions into other qualifying programs such as Medicare, including for individuals eligible due to age or disability. This role plays a vital part in ensuring access to Medicaid coverage and continuity of care by maintaining timely follow-up, conducting ongoing eligibility monitoring, verifying resources during intake, and facilitating effective communication with patients and internal teams. The specialist also participates in regular Medicaid team meetings to support coordinated care efforts and improve enrollment outcomes.
Responsibilities
Medicaid Intake & Application Support
- Assist with initial Medicaid applications for new enrollments, as needed.
- Support collection of resource verifications and required documentation
- Ensure applications are accurately submitted and track submissions.
- Educate applicants on coverage timelines, required follow-ups, and next steps.
Medicaid Conversion:
- Track and support patients through the Medicaid enrollment pipeline.
- Monitor and assist in converting Medicaid enrollees to appropriate programs (e.g., Medicare for disability-eligible individuals).
- Collaborate with eligibility specialists and PACE Team members to maximize program conversions.
Medicaid Renewals:
- Proactively contact patients to collect documentation and provide renewal guidance, including home or center visits and delivering documents to DSS if needed.
- Assist with submitting renewal applications to maintain continuous coverage.
- Record patient interactions and follow-ups in internal systems.
- Coordinate with social services to track renewal status.
Weekly Medicaid Meetings:
- Attend and contribute to internal weekly Medicaid meetings.
- Share updates on Medicaid conversions and renewals.
- Help identify barriers to coverage and recommend process improvements.
Monthly Eligibility Checks:
- Conduct monthly Medicaid eligibility verifications for assigned caseload.
- Update patient records accordingly and flag discrepancies for follow-up.
- Notify patients promptly of any lapses, changes, or upcoming deadlines.
Medicaid-Only Follow-Up (Medicare/Disability):
- Identify patients on Medicaid who may qualify for Medicare due to disability.
- Educate patients on potential eligibility and steps to apply.
- Coordinate with internal benefits counselors or external partners to facilitate transitions.
Other Functions:
- Assist with training new team members or interns on Medicaid processes and workflows.
- Maintain up-to-date knowledge of federal and state Medicaid policies, including changes to eligibility, application processes, or redetermination requirements.
- Provide backup support to other benefit team members during high-volume periods or staff absences.
- Collaborate with social work, care coordination, and clinical teams to identify patients at risk of losing coverage and intervene proactively.
- Participate in internal quality improvement initiatives or audits related to benefits access, data accuracy, or enrollment outcomes.
- Develop or revise patient education materials related to Medicaid and other benefit programs.
- Respond to inquiries from patients, caregivers, or external agencies regarding Medicaid or other related benefits.
- Perform other duties or projects related to patient financial advocacy, benefits optimization, or coverage continuity as assigned by the supervisor.
- Perform other duties as assigned.
Travel Required
- Travel is expected to be between [5% - 15% of the time].
Qualifications
Required Qualifications:
- Requires a high school diploma or GED with a minimum of three years of experience working with Virginia financial assistance programs. Must demonstrate sufficient knowledge to determine and redetermine eligibility for Long Term Care Medicaid benefits in accordance with state, local, and federal guidelines, regulations, and policies.
- Ability to communicate effectively, orally and in writing, with broad spectrum of individuals including but not limited to patients, caregivers, state/federal agencies and medical professionals.
- Ability to comprehend and apply policies and regulations for public assistance programs, sufficient to make eligibility determinations.
- Strong computer and analytical skills
Preferred Qualifications:
- Certification as a Certified Application Counselor (CAC), Virginia Medicaid Enrollment Assister, or related credential is a plus.
- Familiarity with managed care organizations (MCOs) operating in Virginia and their roles in Medicaid coverage.
