Medicaid Pending Specialist
hace 10 días
Indianapolis
Job DescriptionMedicaid Pending Specialist – Indiana Location: Indiana | Statewide Travel Required Position Type: Full-Time | Salaried/Exempt Experienced Indiana Medicaid Professionals – We Want to Hear From You! We are seeking an experienced, highly motivated Traveling Medicaid Pending Specialist to support our skilled nursing and long-term care facilities throughout Indiana. IMPORTANT: Extensive hands-on experience with Indiana Medicaid, specifically long-term care and skilled nursing Medicaid eligibility and Medicaid Pending processes, is REQUIRED for this position. This is not an entry-level Medicaid or Business Office position. We are looking for a knowledgeable professional who understands the complexities of Indiana Medicaid and can step into our facilities ready to make an immediate impact. The Traveling Medicaid Pending Specialist will be responsible for managing Medicaid Pending accounts from initial identification through final eligibility determination and reimbursement, reducing outstanding balances, preventing avoidable denials, and resolving complex eligibility barriers. This position will also serve as a regional Medicaid resource, provide hands-on training and support to facility Business Office teams, and provide Interim Business Office Manager (BOM) coverage as operational needs arise. If you're an Indiana Medicaid expert who enjoys problem-solving, improving processes, and helping facilities succeed, we want to hear from you! What You'll Do – Key ResponsibilitiesMedicaid Pending Management & Revenue Protection Maintain comprehensive oversight of Medicaid Pending accounts across assigned Indiana skilled nursing facilities. Manage Medicaid Pending cases from application through final eligibility determination and reimbursement. Review accounts for application status, financial eligibility, missing documentation, clinical and Level of Care requirements, and other barriers to approval. Ensure Medicaid applications and supporting documentation are accurate, complete, and submitted within required timeframes. Monitor application dates, verification deadlines, retroactive eligibility, approvals, effective dates, patient liability, and outstanding balances. Identify and prioritize aging, high-dollar, high-risk, and stagnant Medicaid Pending accounts. Develop clear action plans and follow-up schedules to move unresolved cases toward approval. Respond promptly to Requests for Information (RFIs), verification requests, and additional documentation requirements. Review Medicaid denials and coordinate corrective actions, reconsiderations, hearings, and appeals when appropriate. Monitor appeal deadlines and maintain organized supporting documentation. Maintain accurate, detailed, and audit-ready Medicaid Pending records. Collaborate with facility and regional leadership to reduce Medicaid Pending balances and improve reimbursement timelines. Indiana Medicaid Expertise Candidates must possess extensive hands-on knowledge of Indiana Medicaid as it relates to skilled nursing and long-term care. Responsibilities include navigating and managing: Indiana Medicaid eligibility requirements for nursing facility and long-term care residents. Indiana Family and Social Services Administration (FSSA) processes and requirements. Division of Family Resources (DFR) Medicaid application and eligibility determination processes. Indiana Medicaid / IHCP (Indiana Health Coverage Programs) requirements applicable to nursing facility services. Indiana PathWays for Aging, including applicable managed care enrollment, coordination, and payer transitions. Nursing Facility Level of Care (LOC) requirements and related clinical documentation. PASRR (Preadmission Screening and Resident Review) requirements and coordination. Financial eligibility, income and asset verification, resource limits, and applicable spend-down considerations. Qualified Income Trusts (QITs/Miller Trusts) when applicable. Patient liability and resident financial responsibility. Medicaid Pending applications, follow-up, and resolution. Requests for Information, additional verification, and documentation deadlines. Medicaid denials, reconsiderations, administrative hearings, and appeals. Retroactive Medicaid eligibility and reimbursement coordination. Managed care requirements affecting eligibility, enrollment, payer transitions, and payment. You will work closely with residents, families, responsible parties, Medicaid caseworkers, state agencies, managed care organizations, and interdisciplinary facility teams to resolve eligibility and reimbursement challenges. Training, Education & Facility Support Serve as a regional subject matter expert for Indiana Medicaid Pending processes. Provide hands-on training and guidance to Business Office Managers (BOMs), Assistant Business Office Managers (ABOMs), and designated facility staff. Educate facility teams on Indiana Medicaid applications, financial verification, eligibility requirements, patient liability, Level of Care, PASRR, QITs, RFIs, denials, and appeals. Assist with onboarding and training newly hired Business Office Managers and Assistant Business Office Managers. Provide guidance on Indiana Medicaid managed care processes and payer transitions. Conduct Medicaid Pending account reviews and identify opportunities to improve case management. Support regional Medicaid Pending initiatives, audits, training programs, and process improvement efforts. Identify recurring barriers and develop sustainable solutions to improve application accuracy, approval timelines, and reimbursement. Interim Business Office Manager Coverage In addition to Medicaid Pending responsibilities, this position will provide Interim Business Office Manager coverage during facility vacancies, leaves of absence, leadership transitions, or other operational needs. Responsibilities may include: Managing accounts receivable, private pay, patient liability, and Medicaid Pending accounts. Maintaining accurate census information and payer classifications. Supporting resident admissions, payer verification, and financial documentation. Completing admission financial reviews and assisting with deposits. Supporting resident trust accounting, including RFMS oversight and reconciliation. Assisting with pre-billing activities, triple checks, and month-end billing readiness. Participating in accounts receivable meetings and financial counseling. Working collaboratively with Administrators, Admissions, Social Services, MDS, Nursing, and regional leadership. Evaluating Business Office operations and identifying immediate revenue cycle risks. Implementing corrective action plans to improve collections, documentation, and operational efficiency. Required Experience & Qualifications Candidates must meet the following requirements to be considered: Extensive Indiana long-term care Medicaid experience – REQUIRED. Direct experience managing Medicaid Pending accounts within skilled nursing or long-term care facilities – REQUIRED. Strong working knowledge of Indiana Medicaid eligibility, applications, financial verification, patient liability, and reimbursement. Familiarity with Indiana FSSA, DFR, IHCP, and applicable Indiana PathWays for Aging processes. Experience navigating nursing facility Level of Care requirements, PASRR, financial eligibility, and Medicaid documentation. Demonstrated ability to manage complex Medicaid Pending cases, resolve eligibility barriers, and reduce outstanding balances. Experience handling Medicaid denials, Requests for Information, reconsiderations, hearings, and appeals. Strong understanding of skilled nursing Business Office operations and revenue cycle management. Ability to work independently, prioritize high-risk accounts, and manage multiple deadlines. Ability and willingness to travel throughout Indiana based on facility and operational needs. Candidates without direct Indiana long-term care Medicaid experience may not meet the requirements for this position. Additional Qualifications High school diploma or equivalent required. Associate or bachelor's degree in Healthcare Administration, Business, Finance, or a related field preferred. Previous experience as a Business Office Manager, Medicaid Pending Specialist, Medicaid Coordinator, or skilled nursing revenue cycle professional strongly preferred. Experience with PointClickCare (PCC) preferred. Experience with National Data Care Resident Funds Management System (RFMS) preferred. Strong organizational, analytical, documentation, and problem-solving skills. Excellent communication and interpersonal skills. Ability to work effectively with residents, responsible parties, facility leadership, Medicaid representatives, caseworkers, and interdisciplinary teams. Experience training, mentoring, or coaching Business Office staff preferred. Ability to adapt quickly to different facility environments and operational challenges. Who Will Thrive in This Role? We're looking for someone who doesn't simply monitor Medicaid Pending accounts — you take ownership and drive them toward resolution. The ideal candidate is someone who: Knows Indiana Medicaid: Understands the eligibility requirements, application processes, and challenges specific to Indiana skilled nursing facilities. Takes Initiative: Identifies barriers, develops action plans, and follows through until cases are resolved. Protects Revenue: Understands the financial impact of Medicaid Pending accounts and works proactively to reduce outstanding balances. Solves Problems: Can navigate complex financial, clinical, and documentation challenges. Supports Facility Teams: Enjoys training and mentoring Business Office professionals. Adapts Quickly: Is comfortable traveling between facilities and providing immediate operational support. Delivers Results: Takes pride in improving Medicaid approval timelines, reducing denials, and strengthening revenue cycle performance. Travel Requirements Regional travel throughout Indiana is required based on facility needs, Medicaid Pending initiatives, training, and Interim Business Office Manager coverage. Candidates must be comfortable working on-site at multiple skilled nursing facilities and adjusting travel schedules based on operational priorities. Why Join Our Team? This is an opportunity to use your Indiana Medicaid expertise to make a meaningful impact across multiple skilled nursing facilities. You'll have the opportunity to: Serve as a regional Medicaid subject matter expert. Work directly with facility and regional leadership. Help facilities resolve complex Medicaid Pending accounts. Protect revenue and strengthen financial performance. Train and develop Business Office teams. Support operational improvements across multiple facilities. Expand your experience in regional skilled nursing revenue cycle operations. Ready to Put Your Indiana Medicaid Expertise to Work? If you have extensive hands-on experience with Indiana long-term care Medicaid, understand the complexities of Medicaid Pending accounts, and enjoy solving challenges that directly impact facility financial performance, we encourage you to apply! Traveling Medicaid Pending Specialist – Indiana Bring your expertise. Drive results. Make an impact. Apply Today! Equal Opportunity Employer We are committed to maintaining a diverse and inclusive workplace and are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, gender, age, national origin, disability, veteran status, or any other legally protected status.
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