Medicaid Coordinator

Reports To: Director of Accounts Receivable
Schedule: Full-Time, 40 hours per week, Monday through Friday, 8:00 AM to 4:30 PM (In-Office Position)
Pay Range: $26.00 to $32.00 per hour, depending on experience

*$1,500 Sign On/Retention bonus*

Position Summary

The Medicaid Coordinator is responsible for managing and monitoring the Massachusetts Medicaid (MassHealth) application process for residents from initial application through approval and ongoing eligibility maintenance. This role is also responsible for processing monthly Medicaid billing, resolving billing issues, and ensuring compliance with all MassHealth requirements.

The Medicaid Coordinator works closely with facility Business Office teams, residents, families, attorneys, and third-party representatives to facilitate successful Medicaid eligibility determination and reimbursement.

Education & Experience Requirements

• Associate degree preferred, or a minimum of three (3) years of equivalent work experience.
• Prior experience processing MassHealth insurance applications and Medicaid billing required.
• Experience in a nursing home or long-term care setting strongly preferred.

Key Responsibilities

• Process and monitor Medicaid billing and follow up on outstanding claims, denials, and reimbursement issues.
• Manage Medicaid reviews, redeterminations, and resident conversions.
• Meet with residents and family members to gather required documentation and provide guidance throughout the MassHealth application process.
• Ensure all required screenings, forms, and SC-1 documentation are completed accurately and submitted timely.
• Communicate resident financial responsibilities, including patient liability requirements.
• Monitor application status and follow up with state agencies, attorneys, guardians, and third-party administrators as needed.
• Oversee and track patient liability calculations and collections.
• Maintain accurate records and documentation related to Medicaid eligibility and billing.
• Collaborate with Business Office personnel to resolve issues that may impact eligibility, billing, or reimbursement.
• Ensure compliance with all MassHealth regulations, policies, and deadlines.

Qualifications

• Prior Medicaid billing experience required.
• Working knowledge of the Massachusetts MMIS system required.
• Demonstrated experience with the Massachusetts Medicaid (MassHealth) application process required.
• Prior experience in a nursing home, skilled nursing facility, or long-term care environment strongly preferred.
• Strong organizational, analytical, and problem-solving skills.
• Exceptional attention to detail and accuracy.
• Excellent verbal and written communication skills.
• Ability to manage multiple cases, deadlines, and priorities effectively.
• Proficiency with Microsoft Office applications and electronic billing systems.
• Reliable transportation and the ability to travel between facilities as needed.

Skills & Competencies

• Strong customer service and interpersonal skills.
• Ability to work independently while collaborating effectively with multiple stakeholders.
• Knowledge of healthcare reimbursement and Medicaid regulations.
• Ability to maintain confidentiality and handle sensitive financial and resident information professionally.
• Strong time-management and follow-through skills.