Job Description Summary Role:
The Medicaid Eligibility Specialist performs verification of benefits and obtains authorizations in accordance with all state, federal and third party payor contractual requirements.
Job Description
DCF application experience required.
Qualifications:
- High School Diploma or GED
- Minimum of one (1) year of medical billing and collection or office experience
- Knowledge of third party billing and state and federal collection regulations preferred
- Ability to prioritize and multi-task independently with little guidance
- Must be self-motivated and service oriented
- Excellent written and verbal communication skills
- Accurate typing and data entry skills
Competencies:
- Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advanced electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Job Responsibilities:
- Scans admissions for patients without insurance and files Medicaid applications
- Coordinates with families, social workers, patients, etc.
- Performs insurance benefit verification for all payors.
- Obtains authorization as required by plan benefit.
- Processes incoming correspondence from payors.
- Resolves any issues with coverage and escalates complicated issues to the Supervisor.
- Ensures timely, complete and accurate processing of benefit information.
- Prepares monthly nursing home room and board invoices.
- Collaborates with Medicaid Eligibility Vendor to obtain Medicaid eligibility.
- Obtains patient responsibility payment as needed.
- Performs other duties as assigned.
Job Type: Full-time
Pay: $19.10 - $27.51 per hour
Benefits:
- 401(k)
- 401(k) matching
- 403(b)
- 403(b) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Paid training
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
Experience:
- Customer service: 1 year (Preferred)
Location:
Work Location: Remote