Benefits & Claims Specialist, PACE Program, Full-time

Job Details: Salary Range: Undisclosed, a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } Job Summary Under the supervision of the VP of Finance and the Executive Director, the Benefits and Claims Specialist assists participants and families throughout the Medicaid application process and maintains accurate logs of Medicaid eligibility.

The role is responsible for day‑to‑day claims processing and adjudication activities while providing support to vendors and internal teams. As the team lead for the claims processing function, this position also contributes to workflow development, process improvement initiatives, and applies advanced technical expertise to support complex claims scenarios.

Additionally, the role assists Medicaid Representatives with challenging situations, which may include meeting with participants, families, social workers, and county personnel.

Qualifications

Minimum Qualifications Associate’s degree in Finance, Business, or Healthcare Administration Knowledge of Medicaid system and benefits 3 Years of Medical Claim Adjudication/Processing Experience 1 Year of PACE Specific Medical Claim Processing Experience Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.

Be medically cleared for communicable diseases and have all immunizations up to-date before engaging in direct participant contact. Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.

Competencies, Preferred Knowledge, Skills, and Abilities Knowledge of Medicaid system and benefits Bachelor’s degree in Finance, Healthcare Administration, Business, or related field preferred Certified Medical Reimbursement Specialist

• American Medical Billing Association preferred Physical Demands and Work Environment This position operates in a standard office environment and requires the ability to engage in prolonged periods of computer work, including viewing a screen and performing keyboard and mouse functions. The role requires the ability to communicate clearly in person, over the phone, and electronically. The employee must be able to lift, carry, or move up to 25 lbs for transporting files or materials, as needed. Work may involve occasional interruptions and shifting priorities based on operational needs. Position Type and Expected Hours of Work This position may be designated as either full-time, part-time or PRN based on organizational needs. The part-time position is scheduled Monday through Friday, 8:00 a.m. to 12:00 p.m. Travel : None