Medicaid Eligibility Patient Support Rep

Position Summary:
The Patient Support Representative Screens and interviews patients, family members and/or friends to determine the patient's linkage to the appropriate program(s). Facilitates accurate completion of needed program applications, obtaining all necessary information/documents to enable an accurate determination of eligibility. Files applications timely with the designated program state/county office in accordance with applicable regulations. Maintains a caseload of assigned accounts until case is resolved per established guidelines. Responsible for monitoring assigned caseload ensuring accounts are worked timely and filing deadlines are met. Maintains Daily To-Do list in a current status. Communicates account status to hospital staff as necessary. Performs other duties as assigned. Pay is between $16.50 - $19.00 DOE

Essential Job Functions:
  • Proficient in the ability to screen and evaluate patients for federal and state assistance programs.
  • Maintains an assigned caseload of 25-50 accounts
  • Responsible for addressing staff questions and providing accurate directives on accounts
  • Provides assistance to the Lead in completing detailed reviews of in-house and post discharge accounts and provides directives to specialists regarding all work efforts needed
  • Provides assistance to the Lead in reviewing and assigning ER, IP, VOC and post-discharge Medi-Cal account referrals
  • Forwards pending case numbers to appropriate hospital staff members on all In-House referrals
  • Supports in-bound calls from hospitals and patient advocates
  • Provides assistance to the Lead with re-assigning caseloads as needed
  • Reviews monthly deadline reports to ensure deadlines are met
  • Assists with working accounts for staff that are absent, on vacation or backlogged
  • May assist with client site visits as needed.
  • Participates in ongoing and comprehensive new hire training programs as required.
  • Assists with administrative functions in support of the team, including tasks such as troubleshooting and working complex cases.
  • Promote and maintain harmonious and effective relationships and communication with other departments and clients
  • Follows policies and procedures to contribute to the efficiency of the office.
  • Covers and assists with other office functions as requested

  • Knowledge:
    • Working knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines.
    • An understanding of patient confidentiality to protect the patient and the hospital client.
    • Knowledge of state/county program eligibility regulations including, but not limited to Medi-Cal/ Medicaid, desired.
      • Understanding of medical terminology and diagnosis codes preferred.
      • Prior experience in hospital Admitting, Registration or Business Office a plus.

  • Experience:
    • A minimum two years of Medicaid eligibility or hospital/medical business office experience with government programs and patient interaction.
    • Strong familiarity with a variety of the field's concepts, practices and procedures.
  • Competencies: Demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly.
    • Ability to collect, synthesize and research complex or diverse information.
    • Exceptional customer service and the ability to plan organize and exercise sound judgment.
    • Bilingual a PLUS

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