Medicaid Benefit Specialist

The Medicaid Benefit Specialist is responsible for managing and maintaining public benefits for individuals served under corporate guardianship. This position ensures that all eligible clients receive and maintain appropriate Medicaid coverage and any other public assistance benefits they qualify for. The specialist works closely with guardians, county agencies, healthcare providers, and the Wisconsin Department of Health Services (DHS) to coordinate benefits and resolve eligibility or enrollment issues.

ESSENTIAL DUTIES (FUNCTIONS) include the following:

• Monitor, apply for, and renew Medicaid and any other relevant public benefits (e.g., Medicare Savings Programs, FoodShare, SSI, etc.) on behalf of clients under guardianship.
• Research accounts and resolve potential errors and issues through the audit of accounts from phone calls, emails, and tickets received.
• Work closely with Guardians of Person and/or Estate and Representative Payees to obtain required documentation needed to submit for Medicaid initial applications and renewals.
• Communicate regularly with Income Maintenance Consortia, county agencies, the Social Security Administration, and other benefit-related entities.
• Maintain accurate, timely, confidential documentation in client billing electronic system. Collaborate closely with guardianship staff to align financial and healthcare decisions with benefit eligibility requirements.
• Prepare and submit required reports, renewals, and verifications to ensure continuous benefit coverage.
• Track benefit statuses, deadlines, and renewals to ensure continuity of coverage.
• Advocate for clients' access to benefits and resolve issues related to denials, terminations, or changes in eligibility.
• Stay informed about Medicaid policy updates and changes affecting clients and educate team members accordingly.
• Provide training and guidance to guardianship staff on benefits processes and compliance.
• Attend relevant training, meetings, and community resource events as needed.

*NON-ESSENTIAL DUTIES*

• Assists with scanning, filing and file management
• Attend department and agency meetings as necessary.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to carry out each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High School diploma or GED is required.
• A minimum of one year of customer service experience is required.
• Working knowledge of Wisconsin Medicaid and public benefits systems.
• Knowledge of Wisconsin DHS processes, CARES, and ACCESS systems.
• Strong organizational and documentation skills.
• Ability to manage multiple cases and deadlines.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office and case management software.
• Experience working with vulnerable adult populations preferred.
• Familiarity with SSI, SSDI, and representative payee responsibilities preferred.
• A Criminal Background Check must meet the requirements of the State of WI licensure for day programming.
• A Credit Check is required for this position.

Specialized Skills/Abilities/Knowledge:

EQUIPMENT USED/MACHINERY REQUIRED TO OPERATE:

Includes, but is not limited to:

• Telephone
• Copier
• Computer
• Fax

PHYSICAL DEMANDS: