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Eligibility Specialist - Medicaid Eligibility
Job ID: 11708
Location: Raleigh, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
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:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Will take the patient through the entire Medicaid application process from application to award or denial. Will have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.
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 patients denial reversal
Other Information
Education Requirements:
● Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● 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.
Knowledge/Skills/and Abilities Requirements:
● Analytical, Customer Service, Direct Patient/Family Interaction/ Hospital/Healthcare Experience, Interpersonal, Report Preparation, Strong Written and Verbal Communication skills.
Job Details
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Medicaid Eligibility
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Raleigh
Exempt From Overtime: Exempt: No
Diversity Statement
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
Equal Employment Opportunity
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.
To verify employment eligibility, UNC Health is committed to Form I-9 and the E-Verify process. Learn further E-Verify details in English or Spanish.
UNC Health supports your right to work. View the Right to Work Statement in English or Spanish.
