Medicaid Eligibility Specialist - Full Time - Days at AdventHealth

Date Posted: 3/13/2020

Job Snapshot

  • Job Schedule
    Full-Time
  • Job Category
  • Date Posted:
    3/13/2020
  • Job ID:
    20004115
  • Job Family
    Patient Financial Services
  • Travel
    No
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Palm Coast

Job Description


Description
Medicaid Eligibility Specialist AdventHealth Palm Coast

Top Reasons To Work At AdventHealth Palm Coast
Career growth and advancement potential
Health Insurance Coverage
Great benefits such as: Educational Reimbursement
 
Work Hours/Shift:
Full Time, Days- 1030a-730p

GENERAL SUMMARY:

The Medicaid Eligibility Specialists will assess whether a patient will qualify for various programs. Typically, these programs offer financial assistance from the government. Eligibility specialists may work with Medicare or Medicaid, disability claims, or other government-sponsored programs.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

•            Verifies insurance coverage for all new patients.

•            Reviews coverage and explains specific patient responsibilities such as deductibles, copays, etc. to the patient.

•       working close with hospital employees and patients, interviewing clients in hospital setting to assist them in obtaining maximum benefit coverage, Completion of applications for state and federal programs (including Health Exchange/Marketplace programs)

•            On request, provides patients with an estimated quote of charges for services.

•            Resolves financial problems identified by the patient and addresses them in a timely manner.

•            Reviews daily census for all uninsured patients and/or those who have poor insurance coverage to determine intervention needed. 

•            Meets with all uninsured patients within 24 hours of admissions by completing a thorough financial assessment to ensure we have screened those patients for county, state and federal programs. 

•            Gathers required financial information by phone or by direct interview in a professional manner, demonstration regard for dignity of all patients and family members.

•            Maintains up-to-date knowledge regarding medical insurance’s coverage policies.

•            Maintains current knowledge on all federal, local and state programs in order to determine a payer source for uninsured patients.

•            Meets with patients and completes application for Social Security Administration disability applications, Medicare and Medicaid/Office of Disability of Determination.

•            Review discharge list and contacts any patients that have not completed making financial arrangements.

•            Discusses payment arrangements on prior accounts with patients via phone or walk in’s

•            Assists Care Management team in following up and updating patient encounters with Authorizations for In Patient Admissions via EQHealth.

•            May provide Medicaid Screening services and bill tracking at any Central Florida Division-North Region Campus, location subject to change based off the needs of the department.

•            follow ups on accepted encounters via work items through Cerner.

•       Collaborates with physicians, patients and family members to formulate an optimal plan of care that meets all the medical, psychosocial and financial needs of each patient, Analyze medical cases for appropriateness.

•       Plan and coordinate all phases of care in conjunction with the Hospitalist, Physicians, and Case Managers for both in the inpatient and outpatient settings, Review inpatient cases daily.

•       Complete inpatient rounds and report to Hospitalists.

•       Educate patients on the eligibility requirements and application process for Medicaid or Social Security Disability.

•       Complete assessments for patients and communicate with the staff, families, and guardians, regarding patients' needs.

•       Assist patients in applying for Medicaid, SSI, SSDI, Medicaid, ICP, County Health Programs,

•       Establish and maintain positive relationships and communications with employees, hospital leaders, and government agencies.

•       Verbally translate documentation from English to Spanish to ensure patients' language barriers are met to avoid delays in transition.

•       Train and educate co-workers in Medicaid and Social Security regulations, as well as community resources available to meet the patients' needs.

•       Communicates daily with government offices for follow up on award letters, approvals, authentication of patients, appeals, etc.

•       Compile Medical records, financial and personal documentation from patients, family members and/ or hospital staff reviewing medical records and taking all necessary action to expedite benefit approval.

•       Manually data entry on all cases whether approved, closed or pending.

•       Requests DUVA bills from emergency room physicians to help meet share of cost.

•       Work closely with neighborhood pharmacies to help assist patients meet share of cost with medications.

Constant communication via phone, email and letters
Qualifications
What You Will Need:

KNOWLEDGE AND SKILLS REQUIRED:
  • Technical knowledge is needed in the medical insurance billing field through at least 1 year experience.  Such knowledge may be obtained through some professional training or college education or by on-the-job training.
  • Medical terminology and proficient computer skills required.
  • Good customer service skills needed.

EDUCATION AND EXPERIENCE REQUIRED:

  • High school diploma or equivalent required. 
  • Two years Patient Access Experience and or two years Financial Education experience acceptable  
Job Summary:

The Medicaid Eligibility Specialists will assess whether or not a patient will qualify for various programs. Typically these programs offer financial assistance from the government. Eligibility specialists may work with Medicare or Medicaid, disability claims, or other government-sponsored programs.



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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