Eligibility specialist job description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Will take the patient through the entire Medicaid application process from application to award or denial. Will have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.
Responsibilities:

1. 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.
2. 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 patients denial reversal

Other Information
Education Requirements:
● Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).
Professional Experience Requirements:
● If an Associate's degree: Two (2) years of experience in a social services or healthcare organization.
● If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.



Job Details
Legal Employer: NCHEALTH
Entity : Shared Services

Organization Unit : Medicaid Eligibility
Work Type : Full Time

Standard Hours Per Week : 40.00
Work Schedule : Day Job
Location of Job : US:NC:Raleigh
Exempt From Overtime : Exempt: No

Salary: $32,000 - $42,000

Primary Objectives of Position: Supports the outreach and eligibility function of the Community Engagement Team (CET) including Board Initiatives, Grant activities, and Business Service events. Responsible for establishing and cultivating relationships with participants, employers, and community agencies to achieve project enrollment goals. This team provides Services Information, conducts eligibility for all programs and grants, and initiates the comprehensive assessment using Motivational Interviewing skills.

Essential Job Functions:

• Develop relationships with community organizations, educational facilities, and social service agencies to encourage enrollment in workforce center programs.
• Conduct outreach presentations as needed with a wide range of audiences including high school students, parents, educators, older adults, transitioning job seekers at halfway houses, etc.
• Identify, develop, and implement strategic outreach and recruitment opportunities to ensure proper quantity and quality of talent is available to meet employer needs.
• Appropriately connect job seekers to open positions, resulting in employment. Additionally, connect job seekers to opportunities for training and development and other career center services to increase opportunities for employment.
• Establish and maintain knowledge of community and participate in community events and other activities including collaborative recruitment strategies with community partners. This may require a weekend and evening work schedule.
• Assist with Rapid Response.
• Enroll job seekers into Wagner-Peyser and complete Initial Assessments.
• Deliver training in various classroom formats, using relevant training materials and a variety of media to address the individual needs of learners.
• Assist individuals with understanding and completing program enrollment processes, conduct eligibility assessment and submit applicants for approval through the WIOA programs.
• Provide services to rural communities per the Rural Service Strategy and SNAP expansion plan.
• Establish and maintain knowledge of community and participate in community events and other activities including collaborative recruitment strategies with community partners. This may require a weekend and evening work schedule.
• Acquire and maintain knowledge of market research tools and the trends in the industry or sector to appropriately guide and direct job seekers to placement or education.
• Ensure that customer files and records are maintained in accordance with legal requirements and Company policies and procedures.
• Utilize Extreme Customer Service behaviors in all interactions with internal and external customers.

Other Job Duties: This job description is not intended to be all-inclusive. The employee may be requested to perform other reasonable related duties as assigned by the immediate supervisor and other management as required. The company reserves the right to revise or change job duties as business requirements dictate. It is also understood that the company reserves the right to change work schedules as required, including requiring overtime.

Physical Demands/Work Environment: Physical requirements include carrying/lifting to 25 pounds, frequently; up to 10 pounds, regularly; and up to 25 pounds, occasionally. Visual acuity, speech, and hearing; hand and eye coordination and manual dexterity necessary to drive an automobile and operate computer keyboard and basic office equipment; subject to carrying, lifting, twisting, and reaching to perform essential job functions. Working conditions are primarily in an office environment with occasional travel to other locations.

Education : Associate's degree or equivalent experience is required.

Experience : Minimum of two years' experience in case management or workforce development with at least one year's experience working with computer systems for data entry and data review. Previous experience in staffing and recruiting is preferred.

Required Competencies: Extreme Customer Service focus, learning orientation, communication proficiency, teamwork orientation, technical capacity.

Skills/Abilities: Understand the data entry, and customer requirements for all funding streams. Must demonstrate attention to detail. Understand and follow program policy. Knowledge of employment recruiting practices. Ability to engage, understand, and respond to the needs of business accounts. Ability to present exceptionally well in a group setting. Proficient with Microsoft Office. Excellent verbal and written communications skills are necessary. Ability to accurately document customer interactions through well-written case notes is a must. Knowledge of business practices within specific industry is preferred. Must have the ability to work in a fast-paced and diverse environment. Strong familiarity with regulatory entities and their laws and guidance that apply to job posting and recruitment, individual training accounts, employed worker training, customized training, and on-the-job training.

Additional Requirements: Must have a valid driver's license and adequate vehicle insurance coverage.

Diversity is at the heart of our business. It is key to our people's passion for serving individuals and communities who seek to build a stronger workforce. We strive to create a work environment that provides all our team members with equal access to information, development and opportunity. Furthermore, our commitment to diversity and inclusion is deeply rooted in the values instilled by our Four Cornerstones and commitment to Extreme Customer Service. We recognize that differences in age, race, gender, nationality, sexual orientation, physical ability, thinking style and background bring richness to our work environments. Such differences help us connect better with the workforce development needs of people we serve in our communities. We believe that attracting, developing and retaining a base of employees that reflects the diversity of our customers is essential to our success.

Equal Opportunity Employer

Dynamic Workforce Solutions is an equal opportunity employer/program and auxiliary aids and services are available upon request to individuals with disabilities.

Job Posted by ApplicantPro

The Eligibility Specialist determines applicant eligibility for third party reimbursement, processes data necessary for admission of new patients into health services, ensure proper coding for insurance billing, and handle inquiries from prospective applicants and patients.
*Essential Functions*

Essential functions are those tasks, duties, and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable.
* Conduct eligibility for clients following procedures and guidelines specific to each program.
* Ensure that clients do not have another payer source such as Medicaid, Medicare, ADAP, and any other third party insurance.
* Register clients into the CPCDMS.
* Complete all necessary paperwork.
* Performs data entry of eligible clients into electronic system.
* Maintains up-to-date and orderly eligibility files.
* Conducts renewal eligibility as required by each program.
* Confirms eligibility appointments with clients.
* Sets initial service appointments once eligibility has been determined.
* Provides clients with list of required eligibility documentation.
* Participates in the Performance Improvement Program.
* Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.
* Promotes effective working relations and works effectively as part of a team to facilitate the department's ability to meet its goals and objectives.
* Attends all required safety training programs and can describe his/her responsibilities related to general safety, department/service safety, specific job-related hazards.
* Attends all required safety education programs.
* Operates assigned equipment and performs all procedures in a safe manner as instructed.
* Maintains work area and equipment in condition required by Legacy standards.
* Demonstrates proper body mechanics in all functions.
* Checks on the patient's environment and equipment to insure safety. Reports safety concerns promptly to appropriate personnel.
* Follows Legacy's exposure control plans/blood borne and airborne pathogens.
* Demonstrates knowledge of techniques, procedures and correct use of protective barrier equipment (Universal Precautions).
* Assures a safe environment by instituting appropriate control measures.
* Attends annual education programs.

*Education & Training Requirements*
* High School Diploma or equivalent required.
* Bilingual preferred

*Work Experience Requirements*
* A minimum of 3-5 years of medical billing experience preferred.
* Some training or background in ICD-A / CPT codes preferred.
* Ability to understand and practice bookkeeping and accounting terminology required.
* Knowledge of medical terminology and billing practices preferred.
* Ability to operate computers and other office machines required.
* Must be able to take responsibility and work under pressure.

Job Type: Full-time

Pay: $15.00 - $21.00 per hour

Schedule:
* No weekends

Language:
* Spanish (Required)

Work Location: One location