Medicaid Eligibility Advocate (Finance)
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The Medicaid Eligibility Advocate is responsible for acting as the patient advocate to secure some form of sponsorship for uninsured/underinsured, medically necessary services. The associates follow the Stratified processing environment principles of stratification by focusing mainly on inpatient and high dollar outpatient account most likely to qualify for Medicaid.Minimum Required: HS Diploma/GED required. Bachelor's Degree preferred. | HFMA certification preferred. Preferred: Bilingual associates will need a Certificate of Qualified Medical Interpreter. | Minimum Required: 3-4 years of experience as a Social Services Income Maintenance Case Worker or previous experience in a hospital-based Medicaid Referral/Eligibility Program or relevant experience in the healthcare revenue cycle and/or Epic Revenue Cycle applications.Medicaid Eligibility Screening Process:
Conducts financial screening of uninsured patients at bedside or with other responsible party to gather pertinent information to determine potential Medicaid or other program eligibility.
Uses experience and detailed knowledge of all Local, State and Federal program requirements to determine which program(s) best coincide with the needs of the patient.
Assesses the need for and obtains all pertinent information relevant to the selected program(s).
Medicaid Eligibility Application Submission:
Serves as patient advocate by assisting patients with matters pertaining to Medicaid, Social Security and Hospital Financial Assistance eligibility.
Represents patients for all applicable programs. Obtains signed patient consents enabling hospital staff to serve as authorized representatives on behalf of the patient for all County, State and Federal programs.
Interacts with County Case Workers, addresses issues, answers question and assists with all aspects of the application process including, but not limited to, appropriate liquidation of assets and resources. Cases are followed from initiation to completion.
Completes County Department of Job and Family Services applications along with Social Security applications.
Delivers forms and medical information via electronic communication to Social Security office for Social Security Disability and Supplemental Security Income applications.
Obtains copies of pertinent medical evidence to send to Disability Determination Services.
Medicaid Eligibility Follow Up:
Assures that each pending Medicaid account is reviewed and managed in a timely and appropriate manner.
Travels to County Department of Job and Family Services or other agencies to assist with interviews, applying on the patient's behalf, or submitting information.
Travels to businesses, other hospitals or agencies to obtain needed information as required.
Reviews all Medicaid application denials to determine if these denials are in accordance with state and federal regulations.
Represents the patient and the hospital during local and state appeals, providing the Hearing Officer with information conducive to a favorable decision. Presents arguments in favor of patient's eligibility and enters all relevant exhibits into the official Hearing Records in the proper manner.
Recognizes potential application of precedence in previous hearing decisions and demonstrates leadership skills through problem solving abilities.
Medicaid Eligibility Documentation & System Updates:
Verifies patient data and updates system as needed.
Documents all contacts, correspondence, verifications and reasons for denials for future reference by department and other departments that require it.
Updates the systems unit when Medicaid is not attainable so that other financial arrangements can be made. Confirms Medicaid eligibility and enters eligibility into the computer to ensure proper billing reimbursement.
Medicaid Eligibility Communication:
Utilizes communication skills to obtain necessary information while conveying sensitivity to patient/family. When necessary, tested bilingual associates will interact with non-English speaking patients.
Maintains close contact with patients/family members to satisfy concerns and provide additional information about applying and qualifying for programs.
Contacts physicians or other medical personnel and utilizes medical documents regarding the patient's medical conditions to determine length of disability.
Consults with the manager on difficult cases or as issues arise.
Attends required educational sessions and completed any requirements of those sessions.
Misc:
Other Duties as assigned.
Maintains up to date detailed knowledge of Medicaid and Social Security programs, rules, guidelines and laws that govern the agency's application and referral process.Medicaid Eligibility Screening Process:
Conducts financial screening of uninsured patients at bedside or with other responsible party to gather pertinent information to determine potential Medicaid or other program eligibility.
Uses experience and detailed knowledge of all Local, State and Federal program requirements to determine which program(s) best coincide with the needs of the patient.
Assesses the need for and obtains all pertinent information relevant to the selected program(s).
Medicaid Eligibility Application Submission:
Serves as patient advocate by assisting patients with matters pertaining to Medicaid, Social Security and Hospital Financial Assistance eligibility.
Represents patients for all applicable programs. Obtains signed patient consents enabling hospital staff to serve as authorized representatives on behalf of the patient for all County, State and Federal programs.
Interacts with County Case Workers, addresses issues, answers question and assists with all aspects of the application process including, but not limited to, appropriate liquidation of assets and resources. Cases are followed from initiation to completion.
Completes County Department of Job and Family Services applications along with Social Security applications.
Delivers forms and medical information via electronic communication to Social Security office for Social Security Disability and Supplemental Security Income applications.
Obtains copies of pertinent medical evidence to send to Disability Determination Services.
Medicaid Eligibility Follow Up:
Assures that each pending Medicaid account is reviewed and managed in a timely and appropriate manner.
Travels to County Department of Job and Family Services or other agencies to assist with interviews, applying on the patient's behalf, or submitting information.
Travels to businesses, other hospitals or agencies to obtain needed information as required.
Reviews all Medicaid application denials to determine if these denials are in accordance with state and federal regulations.
Represents the patient and the hospital during local and state appeals, providing the Hearing Officer with information conducive to a favorable decision. Presents arguments in favor of patient's eligibility and enters all relevant exhibits into the official Hearing Records in the proper manner.
Recognizes potential application of precedence in previous hearing decisions and demonstrates leadership skills through problem solving abilities.
Medicaid Eligibility Documentation & System Updates:
Verifies patient data and updates system as needed.
Documents all contacts, correspondence, verifications and reasons for denials for future reference by department and other departments that require it.
Updates the systems unit when Medicaid is not attainable so that other financial arrangements can be made. Confirms Medicaid eligibility and enters eligibility into the computer to ensure proper billing reimbursement.
Medicaid Eligibility Communication:
Utilizes communication skills to obtain necessary information while conveying sensitivity to patient/family. When necessary, tested bilingual associates will interact with non-English speaking patients.
Maintains close contact with patients/family members to satisfy concerns and provide additional information about applying and qualifying for programs.
Contacts physicians or other medical personnel and utilizes medical documents regarding the patient's medical conditions to determine length of disability.
Consults with the manager on difficult cases or as issues arise.
Attends required educational sessions and completed any requirements of those sessions.
Misc:
Other Duties as assigned.
Maintains up to date detailed knowledge of Medicaid and Social Security programs, rules, guidelines and laws that govern the agency's application and referral process.
