Medicaid Eligibility Specialist

About the role

Jordan Valley Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple: Improve our community’s health through access and relationships. By working collaboratively with partners and continually innovating, JVH strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare.

Responsibilities

• Evaluate and process complex Medicaid applications, renewals, and case changes.
• Investigate and resolve escalated eligibility issues referred by Tier 1 staff or external stakeholders.
• Analyze income, household composition, residency, citizenship, and other eligibility factors to determine Medicaid eligibility.
• Complete redeterminations and eligibility corrections within established timeliness standards.
• Ensure compliance with all federal, state, and agency policies governing Medicaid eligibility.
• Support quality assurance efforts by reviewing cases and identifying trends or training opportunities.
• Respond to escalated member, provider, and community partner inquiries.
• Explain Medicaid eligibility decisions, enrollment requirements, and program benefits.
• Coordinate with healthcare providers, managed care organizations, and community agencies to facilitate access to services.
• Mentor and train Tier 1 staff on eligibility processes and policy changes.
• Assist with development and maintenance of standard operating procedures.
• Recommend process improvements to increase efficiency, accuracy, and customer satisfaction.
• Document and report on workload, timeliness, and quality measures.
• Participate in audits and compliance reviews as required.
• Assist patients with Medicaid applications, renewals, and changes, including gathering required documentation.
• Determine and issue Presumptive Eligibility for Medicaid in compliance with state and federal guidelines.
• Clearly explain eligibility determinations, coverage timelines, and next steps to patients.
• Track and follow up on applications to ensure continuity of care and coverage.
• Collaborate with registration, billing, care teams, case management, and leadership to support patient access.
• Refer patients to internal programs and external community resources, including housing, food assistance, transportation, and social services.
• Participate in outreach events, enrollment activities, and community engagement efforts as needed.

Qualifications

• Minimum of three (3) years of experience in Medicaid eligibility, public assistance programs, patient access, insurance enrollment, or related field.
• Experience interpreting policies and making independent eligibility determinations.
• Associate’s degree or relevant certification.
• Previous experience in an FQHC, community clinic, or safety-net healthcare setting.
• EPIC, electronic health record experience preferred.
• Experience addressing social determinants of health.