Medicaid Specialist

Who We Are

At Entyre Care, our mission is to support caregivers by offering families both emotional and financial support throughout their caregiving journey. We ensure our caregivers have access to the right resources and guidance in all areas of outpatient care, so they feel confident and prepared to care for their loved ones at home. Entyre Care recognizes the essential role caregivers play and are committed to helping them receive fair compensation, allowing them to focus on delivering compassionate, high-quality care.

What We’re Looking For

We are seeking a dedicated and knowledgeable Medicaid Health Insurance Specialist to join our team. The ideal candidate will possess a strong background in researching member insurance issues, counselling patients on insurance plans, and navigating the complexities of MassHealth LTSS services. This role is vital in ensuring that our patients receive the best possible insurance solutions tailored to their needs.

Responsibilities

• Assess and determine Medicaid eligibility for clients, utilizing the knowledge of LTSS services and the specific benefits associated with various forms and waivers of Medicaid.

• Provide guidance and counsel to patients regarding insurance plans, discussing risks and benefits to help them make informed choices.

• Engage with patients in their homes to assist with onboarding, ensuring a smooth transition into necessary services.

• Demonstrate a strong understanding of various plans with the Virginia health insurance system to aid clients in navigating their options.

• Research member insurance issues, addressing concerns related to benefits and eligibility, and help clients understand their options.

• Familiarize yourself with prior authorization processes related to LTSS and Medicaid services, including hospice services and personal care assistance (PCA).

• Display ambition and innovation in developing patient solutions through insurance options, constantly seeking to improve processes.

• Maintain a self-starter mentality by tracking key quantifiable metrics related to patient enrollment documents to enhance efficiency in the enrollment process.

• Practice keen listening skills to effectively connect with patients during insurance navigation, ensuring their needs are understood and met.

• Communicate effectively with internal staff regarding trends and issues related to insurance enrollment, fostering cooperative problem-solving.

Requirements

• Minimum of 2 years of experience in Medicaid eligibility and enrollment.

• Foundational knowledge in Personal Care Assistance (PCA) is strongly preferred.

• Experience in the insurance industry is strongly preferred.

• Proven experience with client interaction and willingness to travel to patients' homes.

• Strong interpersonal skills with the ability to engage with diverse populations and build rapport.

• Fluency in both English and Spanish is preferred.

• Familiarity with LTSS services, including the benefits of various insurance plans.

• Willingness to undergo training to become a certified application counselor (CAC).

• General knowledge of prior authorizations in LTSS and services covered under Medicaid.

• Self-motivated and proactive approach to finding innovative solutions for patient needs.

• Strong communication skills to convey information clearly and effectively to patients and internal teams.

How We Operate – Non-Negotiable

• “Insanely Great” for Families - Delivered Now: Relentlessly solve caregiver needs with excellence and speed.

• Speed is King - Ruthless Focus: Eliminate distractions and execute on critical objectives with urgency.

• Raise the Bar - Demand A-player performance and continuous improvement from yourself and your team.

• The Speed Algorithm - Question, delete, simplify, and accelerate every process. Remove bottlenecks and friction.

• Act Like Owners - Bold Bets, Fast Action: Take initiative, make bold decisions, and move fast to drive results for families.

The Bottom Line 

This is a high-impact, operational leadership role at the heart of a mission-driven company. If you are energized by building and optimizing our operations at speed—and want to make a difference for millions of families—join us at Entyre Care. 

What We Offer

• 401(K), Health insurance, Life insurance, Dental insurance and Vision insurance.

• Comprehensive PTO including 11 paid holidays, paid time off (PTO), and sick leave.

• Employee Perks: Spending discounts via SmartSpend, financial coaching via SoFi, and pet insurance discounts for any furry friends!