Medicaid is a joint state and federal program in the United States (US) that aims to provide a basic level of healthcare to low income individuals and families that belong to at least one designated Medicaid eligibility category. Existing in some form in every state, numerous Medicaid jobs are typically available for people with varying skill sets. Examples of common positions include Medicaid fraud investigators, electronic data interchange specialists, billing, and eligibility workers.
State agencies usually manage Medicaid programs and receive matching federal funds as reimbursement; as a result, there are a high number of state Medicaid jobs in the US. State Medicaid employees generally are the ones who determine Medicaid eligibility by investigating a potential recipient's income, assets, age, disability, and other mandated qualifying circumstances. Also, there are a significant number of Medicaid fraud jobs where employees investigate cases of people abusing the system to receive free medical care or illicit payments for services rendered. There are also Medicaid billing jobs at the state level, including claims adjudication specialists, billing policy analysts, and electronic data interchange analysts. Each position handles a separate portion of the life cycle of a Medicaid claim, from ensuring claim payments are accurate and have been sent to the agency in accordance with federal rules to setting high-level policy designed to better serve Medicaid recipients.
The private sector also supports numerous Medicaid specialist jobs. Individuals are employed by organizations ranging in size from research hospitals to private clinics. Medicaid service coordinator jobs in the private sector are often created to help a doctor manage his or her Medicaid patient caseload and to conduct outreach in the community.
Billing jobs are common in the private sector, as services rendered by a doctor in private practice or even a public hospital need to be billed to the proper state agency for reimbursement. Medicaid reimbursements tend to be less generous than payments for equivalent services from insurance companies, and the pool of doctors and clinics willing to accept Medicaid clients is limited. In turn, private sector Medicaid jobs are subject to both changes in state agency policy and to the fact that a medical provider may find that the Medicaid portion of his or her practice is not financially sustainable.
Whether in state service or in the private sector, Medicaid jobs do not have one path for employment. The skills that make a good Medicaid specialist depend on if he or she is meeting with recipients to determine eligibility, conducting statistical analysis in a claims database, or setting program policy based on the needs of Medicaid recipients in his or her area. A bachelor's degree in human services or a social science could be helpful, and may be required, for more technical or specialized Medicaid jobs; however, many Medicaid works obtain positions with a high school diploma. Attention to detail, a dedication to serving others, and strong ethics can be considered essential components of any Medicaid career.
