Medicaid Specialist

PACE, a member of Empath Health is seeking a detail-oriented Medicaid Specialist to join our interdisciplinary PACE team in Pinellas County, FL
. In this role, the Medicaid Specialist is responsible for establishing and maintaining Medicaid eligibility for PACE participants. This includes preparation and submission of potential participants' Medicaid applications, tracking and processing redeterminations (RRR), and serving as an organizational liaison to DCF (Department of Children and Families) case managers to expedite the application and enrollment process.

Flexibility to commute between Pinellas, Hillsborough, Manatee, and Sarasota counties.

The Program of All-Inclusive Care for the Elderly (PACE) is a unique care model designed to help older adults remain independent and safe in their own homes.

• Relationship-Based Care with Real Impact:
  Build lasting connections with participants, supporting their independence and mobility—this is a meaningful alternative to inpatient rehab or traditional outpatient care.
• Team-Driven, Preventive Focus:
  Collaborate with physicians, nurses, social workers, and other clinicians in a true interdisciplinary care model focused on prevention and holistic well-being.

• Initiates Medicaid application process for potential participants, including application completion, assisting applicants with gathering and processing verification items, application submission, and coordination with DCF case managers, tracking and follow-up of application status
• Provides initial telephone point of contact with potential participants and participants’ family/care giver and referral sources as needed
• Completing home visits as necessary to aid in this process
• Conducts consistent professional written and verbal communication with referral sources, and documents these communications in the Electronic Health Record
• Requests and tracks requests for records and other required paperwork from doctors’ offices, and other sources as needed
• Maintains Medicaid Tracking database including tracking time to approval from submission to DCF to approval by DCF

Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format

Prepares the Medicaid application from DCF and tracks the participant’s recertification (RRR) with DCF to ensure approval year to year

Supports PACE finance department in validation of Medicaid payments and revenue cycle as needed and requested by Manager and Revenue Manager

Completes and records initial and annual verifications of participants’ incomes.

Maintains and updates participant shared payments for facilities

Coordinates intake of new participants as necessary

Maintains professional affiliations and any required certifications.

Performs other duties as assigned

• Earn Competitive Pay: Your skills and contributions are recognized and rewarded.
• Benefits & Wellness: Medical, dental, vision, life insurance, retirement with company match, plus wellness programs to support your mind and body.
• Industry-Leading PTO: 5+ weeks to rest, recharge, and live your Full Life.
• Grow Your Career: CEU support, tuition reimbursement, and advancement opportunities.
• Make a Difference: Join a mission-driven team dedicated to kindness, compassion, and Full Life Care for All.

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of DCF, Medicaid, and Social Security processes
• Previous experience processing and submitting Medicaid applications
• Extensive knowledge of community resources available to seniors and their families
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• One year experience working with the frail and/or elderly populations required
• Experience working with an Electronic Health Record preferred
• Operates in full compliance with all applicable federal, state and local fire, health, safety, sanitation, Emergency procedures…