Job Summary: The position reports to the Director of Community Education (DCE). Primary responsibilities include assisting in processing Medicaid applications, managing annual recertifications, and ensuring compliance with Medicaid regulations. The team member will collaborate with Case Managers, Medicaid specialists/paralegals, care team members, participants, and family caregivers to streamline processes, minimize delays, and improve the overall participant experience.

Education: High school diploma or equivalent.

Experience: At least 1 year of experience working with the frail elderly population. At least 1 year of Medicaid application experience and/or knowledge required.

Number and Type of Employees Supervised (optional): None

Licensure, Registry, or Certification Required: Valid North Carolina Driver’s License & reliable vehicle

Special Training: Must be able to effectively work in a diverse team environment. Must possess excellent communication, interpersonal and conflict resolution skills.

Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact

Ages of Patients Rendered Care:

• Assists with processing new Medicaid applications and annual recertifications alongside Medicaid Specialist/Paralegals. Ensuring that all requested documentation by the local Department of Social Services (DSS) is uploaded to the Customer Relationship Management (CRM) system and communicated appropriately.
• Performs administrative tasks related to Medicaid documentation and record-keeping. Organizes and maintains accurate Medicaid records, including application forms, supporting documents, and participant correspondence.
• Manages the timely update of enrollment status in the CRM system to ensure accurate reporting to local DSS, care teams, and Medicaid specialist paralegals.
• Acts as a secondary point of contact for Medicaid-related inquiries and follows up as needed after Medicaid specialists/paralegals have made initial contact and education regarding requests for information by local DSS.
• Collaborates with Case Managers to ensure effective coordination of enrollment and Medicaid eligibility processes ensuring timely notifications and submission of information.
• Supports the Enrollment Administrative Assistant by addressing Medicaid-specific phone inquiries, offering guidance and support in answering questions, and resolving issues related to Medicaid eligibility, applications, and status updates.
• Maintains an onsite presence to enhance communication with case managers, enrollment directors, and care team members and facilitates home visits when necessary.
• Oversees the scheduling of home visits for Case Managers to obtain financial information from family caregivers or potential enrollees when required.
• Manages the communication of enrollment changes or updates to care teams and Medicaid specialists/paralegals, ensuring all information is documented accurately in the CRM system and referrals are closed, as needed.
• Supports case management team by conducting home visits and assessments, as needed.
• Manages disability applications and keeps track of any applicants until deemed eligible for Medicaid.
• Manages annual documentation updates and change reports, including address changes, long-term care placements, program disenrollment, and application withdrawals.
• Conducts monthly audits of the Pre-Paid Enrollment Report to ensure accurate Patient Monthly Liabilities (PMLs).
• Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.
• Other duties as assigned.