Medicaid Eligibility Specialist

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Medicaid Eligibility Specialist screens, coordinates and facilitates the Medicaid application process across multidisciplinary entities for patients who meet the eligibility criteria. Obtains eligibility for patients entitled to Medicaid for the purpose of obtaining reimbursement for services provided by Wayne UNC Health Care.

Responsibilities:
1. Performs coverage discovery efforts to verify coverage.
2. Performs thorough, in-depth interviews and evaluates patient’s case for potential eligibility for Medical Assistance Programs.
3. Performs analysis of patient’s assets, income, clinical history and dependent responsibilities. This must be done based on knowledge and interpretation of the federal regulations and Social Security Administration guidelines.
4. Uses the Federal Poverty Level guidelines to determine possible financial eligibility for patients.
5. Communicates and advises patients on complex financial concepts and procedures of applying for Medicaid.
6. In some cases, may act as the authorized patient’s representative for the purpose of initiating an application for benefits as well as conducting any and all activities associated with determination of eligibility of benefits; including the initiation and conduct of administrative and/or judicial, local and up to State appeals.
7. Gathers and provides necessary verification to establish Medicaid eligibility via direct contact with patient and/or patient’s family, employer, financial institution, vital statistics and other collaterals to local Counties Department of Social Services Income Maintenance Caseworker in the county where the patient has residency.
8. Initiates Medicaid application process for patients that may need financial assistance with their hospital bills within the designated deadlines outlined with NCDHHS polices.
9. Complete and fill out all required supporting documentation including Medicaid Applications, NCDHHS forms following the established policies and manuals.
10. Follows up with patient and the Department of Social Services to ensure all pertinent information has been provided relevant to the Medicaid application including disability determination, children and families and Emergency Medicaid..
11. Based on findings, evaluates and Represents the patient(s) if challenges presents including Denials and Unsatisfied approvals/decisions from the local Counties Department of Social Services and facilitates the request for a hearing from the responsible local agencies, State and Chief Hearing Officer for the purpose of reversing a negative decision with or without the patient’s assistance/presence.
12. Presents the patient’s case, examines and cross examines witnesses, and enters evidence into the case file at adjudication hearings to establish patient’s eligibility for Medicaid.
13. Completes an Interview with patients and/or family members in order to screen for possible Medicaid programs and eligibility and document notes in EPIC.
14. Responsible for entering pertinent information into EPIC and closely monitors authorized Medicaid Approval dates as part of the Medicaid eligibility process.
15. After completion of a Medicaid screening, if the patient does not meet the criteria for a Medicaid program, then financial assistance referrals are given to the patient.
16. Provides financial assistance/Access One information to patients.
17. Maintains accounts in Epic Work Queues in a timely manner and completes all documentation.
18. May have travel to patient’s homes in order to complete the Medicaid Applications/forms.
19. Review accounts for Newborns and add coverage including completing Medicaid screenings and applications to ensure timely billing requirements.
20. Works collaboratively with other departments and other UNC health facilities in order to complete the Medicaid screening process.

Other information:
Education
High School graduate or equivalent required.

Licensure/Certification
None required.

Experience
Prior experience with Medicaid administration in a social services or healthcare organization is strongly preferred.

Knowledge, Skills and Abilities
• Demonstrated analytical, customer service, and interpersonal skills.
• Strong organizational skills.
• Good attention to detail and have the ability work with pressing deadlines.
• Ability to prioritize and multi-task.
• Ability to read, write and communicate effectively in English.
• Proficient with MS Office and Epic with the ability to learn new software rapidly.
• Previous experience with Electronic Medical Record (EMR), EPIC preferred

Valid NC Driver’s License: No
If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.


BO-170

01.8524.BO-170.NON-CLIN

Job Details

Legal Employer: Wayne Health

Entity: Wayne UNC Health Care

Organization Unit: Admitting

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: WAYNE MED

Exempt From Overtime: Exempt: No