Medicaid Specialist PACE
Job Description
The PACE Medicaid Specialist leads all Medicaid eligibility activities across the program, including applications, reactivations, and annual redeterminations. In this role you will own process performance, ensuring consistent execution, accountability, and measurable outcomes.
You will also ensure complete, accurate, and timely submissions to the State of Indiana for approval of prospective participants and continued eligibility of current participants. Through proactive management of applications and redeterminations, this role advances census growth, prevents coverage gaps, and protects participant access to care and program revenue integrity
WHO WE ARE
Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.
The PACE program’s vision statement is to provide unmatched, individualized, and joyful care through teamwork that is worthy of praise so that seniors experience the best quality-of-life in their communities. PACE offers seniors and their families the care, nutrition, rehabilitation, transportation, and supportive services they need to remain healthy so that they can live in their own home. Franciscan is known for our mission of caring.
WHAT YOU CAN EXPECT
Candidate will need to be located within a reasonable commute from either our Greenwood & Lafayette Centers or our Dyer & Michigan City Centers.
Candidate will be required to travel to the 2 centers located within their territory as well as out in the community as needed to help assist PACE participants.
Will be reimbursed mileage for travel to other center and while out in the community.
Practice Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m.
No Weekends, Evenings, or Holidays
Own and execute all Medicaid redeterminations, maintaining accountability for continuous participant coverage.
Proactively manage timelines, prioritizing outreach and follow-up to prevent eligibility gaps and disenrollment.
Identify, assess, and resolve risks impacting continued eligibility, determining appropriate actions to sustain coverage.
Oversee Medicaid applications and reactivations, advancing cases from initiation through submission with a focus on timely outcomes.
Assess applicant readiness in partnership with Intake, resolve eligibility barriers, and establish next steps to support enrollment. Collect, verify, and submit documentation through direct outreach and in-person engagement to reduce delays and improve application completeness.
Manage application pipelines and coordinate follow-up and escalation with FSSA/DFR to accelerate determinations
Act as the primary Medicaid eligibility resource for Intake, Social Work, and the interdisciplinary team. Align stakeholders on documentation requirements, timelines, and clear next steps, prioritizing cases based on urgency and impact
QUALIFICATIONS
High School Diploma/GED- Required
Associate's Degree- Relevant Field of Study- Preferred
2 Years- Direct Medicaid eligibility experience, including applications, reactivations, and redeterminations- Required
1 Year- Strong knowledge of Indiana Medicaid eligibility requirements, verification processes, and state systems- Required
1 Year- Experience working directly with FSSA/DFR, including escalation of complex eligibility cases- Required
1 Year- Proven ability to independently manage cases from submission through resolution with limited oversight- Required
1 Year- Experience working with a frail or elderly population- Required
1 Year- Experience in PACE, long-term care, or healthcare enrollment- Preferred
Driver's License - Required
Auto Insurance - Required
TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.