Medicaid Specialist

Description

Department:
Admin

Location:

Muskegon, MI

Compensation: $20.04 - $26.10 / hour

Full Time 40 hours/week | Monday-Friday | 8am-4:30pm

This role is hybrid with office hours required.

Department:
Life Circles PACE | Muskegon, MI

Are you highly organized, detail-oriented, and passionate about helping vulnerable populations maintain access to essential healthcare services? Life Circles PACE is seeking a Medicaid Eligibility Specialist who thrives in a fast-paced, compliance-driven environment and takes pride in ensuring participants receive uninterrupted benefits and care.

In this role, you will be the key point of contact for managing ongoing Medicaid eligibility for our PACE participants. You’ll oversee annual redeterminations, case maintenance, and regulatory compliance with MDHHS and CMS requirements. By proactively monitoring eligibility status, coordinating documentation, and resolving discrepancies with state agencies, you’ll play a critical role in protecting both participant coverage and organizational capitation payments.

This position is ideal for someone who enjoys balancing regulatory accuracy with compassionate communication — serving as a liaison between participants, families, interdisciplinary team members, and state agencies to address changes that may impact Medicaid eligibility.

• Monitor Medicaid Redeterminations: Track and manage annual redeterminations and required updates for participants’ Medicaid eligibility; coordinate the collection and submission of all necessary documentation.
• Maintain Active Coverage: Ensure participants remain enrolled and active in Medicaid for the duration of their eligibility, preventing gaps in coverage and capitation payments.
• Agency Communication: Communicate with MDHHS regarding eligibility issues, discrepancies, status updates, and required actions to support accurate determinations.
• Participant Support &
  
  Education:
  
  Assist participants and care partners in understanding Medicaid requirements; provide guidance during redetermination and support in situations involving income or asset changes, referring to legal/financial counsel when appropriate.
• Documentation & Compliance: Accurately document all eligibility activities, communications, and case status updates in the EHR or designated tracking systems, meeting regulatory and organizational standards.
• Team
  
  Collaboration:
  
  Work closely with interdisciplinary team members and external partners to ensure eligibility changes are reflected in care planning and billing processes.

The above is a summary of the position, it in no way states or implies that these are the only duties this position will be required to perform. If selected for the position you will receive a full job description.

Education & Certification

• Associate’s degree in healthcare administration, social services, or related field required (Bachelor’s preferred), or equivalent experience.
• Current CPR certification (AHA) or ability to obtain through Life Circles.
• Valid Michigan driver’s license and reliable transportation.

Experience

• At least one (1) year of experience working with frail or elderly populations required.
• Experience with long-term care Medicaid or within a PACE organization preferred.

Skills & Knowledge

• Working knowledge of MDHHS systems, Medicaid eligibility policies, and redetermination processes.
• Strong organizational skills with the ability to manage multiple cases and deadlines.
• Excellent written and verbal communication skills.
• Experience with Bridges, CHAMPS, or other MDHHS systems preferred.
• Ability to work independently while collaborating with interdisciplinary teams.
• High level of integrity and commitment to confidentiality and regulatory compliance.

• Career Growth & Development – Take your career to the next level with our tuition assistance programs and educational scholarships.
• Wellness Program & Reimbursement – Prioritize your health and well-being, reimbursed $120 a year!
• Competitive Benefits for Full-Time Team Members – Enjoy Medical, Vision & Dental Insurance starting on the 1st of the month after 30 days of hire.
• Retirement Savings Plan – Secure…