Medical Eligibility Specialist

**$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS**

**Opportunities at Optum, in strategic partnership with Allina Health.** As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**

This position will administer full cycle billing for the Skilled Nursing Facility (TRP) primarily for Medicaid, Medicaid Managed Care, and pending/applying Medicaid payers. This position is responsible to meet with clients and/or family to screen for Medicaid eligibility, assisting and/or facilitating application for Medical Assistance as needed, securing required forms and verifications for submission, and tracking application for completed processing. This position is responsible for accurately verifying eligibility and benefits for insurance coverage, the preparation and submission of complete and accurate billing, and for timely and effective resolution and follow up on collections as well as customer service for the TRP clients and their families. This position will interface with clients, families, county and State agencies, Admissions, Therapy and Social Services staff as well as other facility departments.

**Location:** 3915 Golden Valley Rd, Golden Valley, MN 55422

If you reside near Golden Valley, MN, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.

**Primary Responsibilities:**

+ Meet with clients that lack funding for SNF stay; assist with/facilitate application to Medical Assistance, application for Long Term Care and/or application to State Medical Review Team (SMRT) including securing forms, documentation and verifications required

+ Submission and tracking of Medicaid applications

+ Contact county and state offices regarding application status; proactively pursuing approval of application

+ Complete eligibility query using electronic resources or phone at notice to admit, monthly (Medicare/Medicaid), and/or anytime benefit status changes

+ Identify benefits via electronic resources/phone; interpret results and enter into Point Click Care

+ Complete extended benefit check when requested by Social Workers or Case Managers

+ Obtain Prior Authorizations for continued inpatient stay and/or ancillary therapy Prior Authorizations as required based on payer

+ Notify physician, patient, and/or social worker if unable to complete

+ Obtain estimated cost information and explain waiver process to client/ patient as necessary

+ Notify site Administration when lack of Prior Authorization puts hospital at financial risk

+ Maintain accurate client information and client funding information in Point Click Care and Net Health

+ Ensure systems have compatible information so they can communicate with one another

+ Review and correct claims based on edits from PCC and ePremis. Follow up on unpaid claim balances. Pursue underpaid claims. Review and appeal denied claims to resolution

+ Review and pursue collection of unpaid self-pay/ private pay balances

+ Make outbound collection calls. Assist clients via phone and in-person with information and payment options regarding spend-downs and LOA days that may not be covered

+ Provide options, Partners Care, Med Credit; Facilitate completion so Partners Care applications

+ Communicate to client/family regarding estimated financial impact based on the funding source/status changes

+ Greet patient in a respectful, warm, and professional manner by phone and in-person

+ Follow appropriate processes to provide accounts receivable support on patient's financial account

+ Field questions, provide direction and assistance as needed to non-TRP departments located on the Golden Valley Campus who are providing services to the TRP client/patients. Partner with MES worker on patient status and updates for TRP referrals.

+ Research credit balances to issue refund and/or process replacement claims for recoupment of overpayments as necessary

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ High School Diploma/GED (or higher)

+ 2+ years of experience in assisting with and/or facilitating application to Medical Assistance programs, including knowledge of county and state procedures and requirements for Long Term Care eligibility, application and payment

+ 2+ years of experience in full cycle billing for Skilled Nursing Facilities, Hospital or Physician Service Practice to include experience with Medicaid, Medicare (Part A and B), and primary and secondary Managed Care payer

+ 2+ years of experience and understanding of state, federal, third party, and private pay billing and reimbursement procedures and collection practices

+ Intermediate level of proficiency with computers and programs including Word, Excel, and Outlook

**Preferred Qualifications:**

+ Prior experience with Point-Click-Care

**Soft Skills:**

+ Proven strong customer service skills with an exceptional ability to listen and communicate to others

+ Easily adapt to learn & manage multiple systems

+ Ability to work in a fast paced environments

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

****PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.**

_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._

_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._

_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

\#RPO #Yellow