Medicaid Eligibility Specialist

1 day ago

Goldsboro, North Carolina, United States UNC Health Full time
Job Summary

We are seeking a highly skilled Medicaid Eligibility Specialist to join our team at UNC Health. As a key member of our healthcare team, you will play a critical role in ensuring that patients receive the medical assistance they need to access quality healthcare services.

Key Responsibilities
  • Conduct thorough interviews with patients to determine eligibility for Medicaid programs.
  • Analyze patient data, including income, assets, and clinical history, to determine potential eligibility for medical assistance programs.
  • Use federal regulations and Social Security Administration guidelines to determine financial eligibility for patients.
  • Communicate complex financial concepts and procedures to patients, providing guidance on applying for Medicaid benefits.
  • Act as a patient representative to initiate Medicaid applications and conduct appeals, as needed.
  • Gather and provide necessary verification to establish Medicaid eligibility, including direct contact with patients, family members, employers, and other relevant parties.
  • Initiate Medicaid application processes for patients who require financial assistance with hospital bills, adhering to established deadlines and policies.
  • Complete and submit all required supporting documentation, including Medicaid applications and NCDHHS forms.
  • Follow up with patients and the Department of Social Services to ensure all necessary information is provided for Medicaid applications, including disability determinations, children and family services, and emergency Medicaid.
  • Evaluate and represent patients in challenges, including denials and unsatisfied approvals/decisions from local departments of social services, and facilitate requests for hearings from state and chief hearing officers.
  • Present patient cases, examine witnesses, and enter evidence into case files at adjudication hearings to establish Medicaid eligibility.
  • Enter pertinent information into EPIC and closely monitor authorized Medicaid approval dates as part of the Medicaid eligibility process.
  • Provide financial assistance and Access One information to patients, and maintain accounts in Epic Work Queues in a timely manner.
Requirements
  • High school graduate or equivalent required.
  • Prior experience with Medicaid administration in a social services or healthcare organization is strongly preferred.
  • Demonstrated analytical, customer service, and interpersonal skills.
  • Strong organizational skills, with the ability to work with pressing deadlines.
  • Ability to prioritize and multitask, with a focus on delivering high-quality results.
  • Proficient with MS Office and Epic, with the ability to learn new software rapidly.

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