Medicaid Eligibility Advocate

GENERAL SUMMARY OF DUTIES - Responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Benefits Advisor serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management. DUTIES INCLUDE BUT ARE NOT LIMITED TO:
  • Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
  • Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment.
  • Ensures appropriate signatures are obtained on all necessary forms.
  • Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
  • Complete and file applications.
  • Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
  • Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately.
  • Document progress notes to the patient's file and the hospital computer system.
  • Participates in ongoing, comprehensive training programs as required.
  • Follows policies and procedures to contribute to the efficiency of the office.
  • Covers and assists with other office functions as requested.
  • Will be required to make field visits as necessary.
  • Adheres to and supports organizational IT&S standards, policies, and procedures.
  • Adheres to Code of Conduct.
  • Performs other duties as assigned.

Qualifications:
KNOWLEDGE, SKILLS & ABILITIES
  • 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 clinic/corporation.
  • 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.

EDUCATION
  • College degree preferred or high school diploma (equivalent).

    EXPERIENCE
  • A minimum three years of hospital/medical business office experience with insurance procedures and patient interaction.
  • Strong familiarity with a variety of the field's concepts, practices and procedures.
CERTIFICATE/LICENSE
  • N/A

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