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Medicaid Eligibility Specialist

1 month ago

Goldsboro, United States UNC REX Healthcare Full time

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: Performs coverage discovery efforts to verify coverage. Performs thorough, in-depth interviews and evaluates patient’s case for potential eligibility for Medical Assistance Programs. Performs analysis of patient’s assets, income, clinical history and dependent responsibilities based on knowledge and interpretation of the federal regulations and Social Security Administration guidelines. Uses the Federal Poverty Level guidelines to determine possible financial eligibility for patients. Communicates and advises patients on complex financial concepts and procedures of applying for Medicaid. May act as the authorized patient’s representative for the purpose of initiating an application for benefits and conducting activities associated with determination of eligibility. Gathers and provides necessary verification to establish Medicaid eligibility via direct contact with patient and/or patient’s family, employer, financial institution, and other collaterals. Initiates Medicaid application process for patients needing financial assistance with their hospital bills within designated deadlines. Completes all required supporting documentation including Medicaid Applications and NCDHHS forms following established policies. Follows up with the patient and the Department of Social Services to ensure all pertinent information has been provided relevant to the Medicaid application. Evaluates and represents the patient(s) if challenges present, including denials and unsatisfied approvals/decisions. Presents the patient’s case at adjudication hearings to establish eligibility for Medicaid. Completes interviews with patients and/or family members to screen for possible Medicaid programs and eligibility. Responsible for entering pertinent information into EPIC and monitoring authorized Medicaid Approval dates. Provides financial assistance/Access One information to patients. Maintains accounts in Epic Work Queues in a timely manner and completes all documentation. May travel to patient’s homes to complete Medicaid Applications/forms. Reviews accounts for Newborns and adds coverage including completing Medicaid screenings and applications. Works collaboratively with other departments and UNC health facilities 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 ability to 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. 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 #J-18808-Ljbffr