Eligibility Specialist - Medicaid

Posted today

unc healthHendersonville (NC)

Eligibility Interviewers, Government Programs Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs)

SENIORITY

Senior

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About the role

Job Title Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions are expected and entrusted to represent the organization at each of the four levels of appeals when applications are denied.

Responsibilities: Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient's denial reversal

Other information

Required Qualifications:

Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).Two (2) years of experience in a social services or healthcare organization.
Experience working with data and preparing reports
Strong Written and Verbal Communication skills.

Preferred Qualifications: Spanish language fluency

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