Medicaid Pending Specialist

Traveling Medicaid Pending Specialist - Tennessee & Kentucky

Location: Tennessee & Kentucky Region | Regional Travel Required
Position Type: Full-Time | Salaried/Exempt

We are seeking an experienced Traveling Medicaid Pending Specialist to support skilled nursing facilities throughout Tennessee and Kentucky
.

IMPORTANT:
Extensive long-term care Medicaid experience in BOTH Tennessee AND Kentucky is REQUIRED for this position.

This is not an entry-level Medicaid or Business Office position. The successful candidate must be able to step into the role with a strong working knowledge of both Tennessee and Kentucky Medicaid processes as they relate to skilled nursing and long-term care and immediately provide hands‑on support to our facilities.

The Traveling Medicaid Pending Specialist will be responsible for driving Medicaid Pending accounts from identification through final eligibility determination and payment
, reducing outstanding balances, preventing avoidable denials, resolving complex eligibility barriers, and protecting facility Medicaid revenue.

This position will also serve as a regional Medicaid resource, provide training and support to facility Business Office teams, and provide Interim Business Office Manager (BOM) coverage as operational needs arise.

• Maintain comprehensive oversight of Medicaid Pending accounts throughout assigned Tennessee and Kentucky facilities.

• Drive Medicaid Pending cases toward timely approval and reimbursement.

• Review cases for application status, financial eligibility, missing documentation, clinical/Level of Care requirements, responsible-party involvement, and other barriers.

• Ensure applications and required supporting documentation are completed accurately and submitted timely.

• Monitor application dates, verification deadlines, retroactive coverage, approvals, effective dates, patient liability, and outstanding balances.

• Identify and intervene on stagnant, high-dollar, high-risk, and aging Medicaid cases.

• Maintain clear action plans and follow‑up dates for unresolved accounts.

• Monitor and resolve Requests for Information (RFIs) and requests for additional documentation.

• Review Medicaid denials and determine appropriate corrective action, reconsideration, resubmission, hearing, or appeal.

• Track appeal and hearing deadlines and maintain organized supporting documentation.

• Maintain accurate, detailed, and audit‑ready case documentation.

The successful candidate must have hands‑on knowledge of Tennessee long-term care Medicaid processes, including:

• Tenn Care Medicaid eligibility

• CHOICES nursing facility requirements

• PAE management

• Nursing Facility Level of Care (LOC)

• Financial and medical eligibility requirements

• Qualifying Income Trusts (QITs)

• Patient liability

• Requests for Information and additional verification

• Medicaid denials, reconsiderations, hearings, and appeals

• Managed care requirements affecting eligibility, enrollment, payer transitions, and reimbursement

You will partner with MDS, Nursing, Social Services, physicians, hospitals, and other interdisciplinary partners to resolve clinical documentation and eligibility barriers.

The successful candidate must also have hands‑on knowledge of Kentucky long-term care Medicaid processes, including:

• Kentucky Medicaid nursing facility eligibility

• KLOCS

• Nursing Facility Level of Care (LOC)

• PASRR requirements

• Financial eligibility requirements

• QIT/Miller Trusts

• Patient liability

• Requests for additional documentation

• Medicaid denials, reconsiderations, hearings, and appeals

You will work with residents, responsible parties, facility teams, legal resources, Medicaid representatives, and other partners to resolve eligibility and reimbursement barriers.

• Serve as a regional subject matter resource for Medicaid Pending processes.

• Provide hands‑on training to Business Office Managers (BOMs), Assistant Business Office Managers (ABOMs), and designated facility staff
  .

• Train teams on Medicaid application…