Medicaid Eligibility Patient Support Rep
Santa Ana , California
January 19, 2018
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

A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

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