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BILINGUAL MEDICAID ELIGIBILITY SPECIALIST - MEDICAID ELIGIBILITY

Email Job Job ID: OTH01O2U

Job Description

This position may involve support of various hospitals and health care systems within the UNC Health Care System, but will be employed by Rex Hospital, Inc. (this includes, but is not limited to, for purposes of payroll, health benefits, retirement options, and applicable policies)

Scheduled Work hours: 11:00 a.m. - 7:30 p.m. Tuesday- Saturday

Location: UNC REX, RALEIGH, NC

Job Summary:

Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

Description of Job Responsibilities:

1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.

2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient’s denial reversal

Fluency in English and Spanish preferred

Qualifications

Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).

 

If an Associate's degree: Two (2) years of experience in a social services or healthcare organization.

 

If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.

Primary Location: Raleigh, North Carolina, United States

Department: REXH-75085-UNCHCS REX MEDICAID ELIGIBIL

Shift: Evening Job

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