Medicaid Eligibility Specialist

Role Overview

• Serve as a subject matter expert on Medicaid eligibility rules, including MAGI, ABD, Medically Needy, and waiver programs.
• Analyze complex eligibility cases and provide technical assistance to internal and external stakeholders.
• Interpret and apply state and federal regulations, CMS guidance, and waiver provisions to real-world eligibility scenarios.
• Support system design, testing, and policy implementation related to Medicaid eligibility.
• Develop and deliver training and reference materials for eligibility workers, supervisors, and partners.
• Assist in quality assurance efforts by conducting case reviews and identifying policy gaps or training needs, when needed.
• Liaise with our customers and state and federal agencies on eligibility policy clarifications and updates.
• Any other tasks as assigned by Leadership.

Requirements

• Minimum 10 years of direct experience in Medicaid eligibility determination, policy analysis or training.
• Minimum 3 years of customer service, healthcare navigation, benefits administration, or case management experience.
• Deep understanding of Medicaid eligibility rules under SSA, CMS, and state-specific implementations.
• Demonstrated experience with 1634 and 209(b) state models, spend-down programs and eligibility systems.
• Strong analytical and documentation skills and be detail oriented.
• Strong writing, communication, and stakeholder engagement skills.
• Experience working in a fast-paced, service-oriented environment.
• Prolonged sitting and computer work.
• Must be able to handle confidential sensitive medical information.
• Proficiency with Customer Relationship Management systems (i.e. Salesforce and Tableau), workforce management tools, Google Workplace, Slack and minimal usage of Microsoft Office Suite.

Tech Stack

• Tableau

Benefits

• Flexible remote work environment
• Paid Time Off (PTO) plus all federal holidays off
• Comprehensive benefits package with health, dental, vision insurance group term life, short term disability, long term disability and voluntary life plans.
• Numerous supplemental plans to assist employees.
• Paid maternity, paternity and adoption leave benefits.
• Cancer Experts Now
• supplemental plan
• 401(k) retirement plan with matching contributions.
• Supportive and collaborative work environment.
• Opportunity to be part of a rapidly growing company dedicated to making a difference in the lives of families.