medicaid eligibility specialist

State of South Carolina

<div><div><div><h2 class="jobSectionHeader"><b>Job Responsibilities</b></h2></div><br>
<p></p><div><br>
<div><b>*This is a Temporary Grant position.*</b></div><div><b><br>
The Agency's mission is to be boldly innovative in improving the health and quality of life for South Caro</b><b>linians.</b></div><div></div><div><br>
This position is located in <b>Eligibility, Enrollment and Member Service (EEMS) Processing Centers</b><b>,</b><b> </b><b>Spartanburg</b><b> C</b><b>ounty.</b></div><div>
This is an in-office role and not a telecommute or remote position.</div><br>
<b>
Are you the One? </b>We are looking for an <b>Eligibility Specialist II (MAGI)</b> who will determine/re-determine Medicaid eligibility according to Medicaid policies and procedures. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists complete all assigned eligibility determinations, reviews, and changes in an accurate and timely manner.<ul><li>
Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information. Documents all notes and steps clearly and completely for review and hand-off to other specialists.</li><li>
Demonstrates proficiency in utilizing all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately in the appropriate systems of record.</li><li>
Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.</li><li>
Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.</li></ul><div><b>
The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:</b></div><ul><li>
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.</li><li>
15 days annual (vacation) leave per year.</li><li>
15 days sick leave per year.</li><li>
13 paid holidays.</li><li>
State Retirement Plan and Deferred Compensation Programs.</li></ul></div><br>
<p></p>
<div><h2 class="jobSectionHeader"><b>Minimum and Additional Requirements</b></h2></div>
<p></p><div><p>A high school diploma and relevant program experience in customer services, social services, human services, and/or Medicaid processing.</p><p>
A bachelor's degree may be substituted for the required program experience.</p><p><b><br>
Additional Requirements:</b></p><ul><li>
Overtime and/or weekend work with Deputy approval.</li><li>
Sitting or standing for long periods of time.</li><li>
Lifting requirements: 20 lbs.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Preferred Qualifications</b></h2></div>
<p></p><div><ul><li>Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.</li><li>
Must be able to perform basic mathematical computations.</li><li>
Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.</li><li>
Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.</li><li>
Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Additional Comments</b></h2></div>
<div><p>Please complete the State application to include all current and previous work history and education. <b>A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes.</b><b> </b>All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.<br>
<br>
<i>The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.</i></p></div></div></div>

Eligibility Specialist II (MAGI) / 61100189TG

<div><div><div><h2 class="jobSectionHeader"><b>Job Responsibilities</b></h2></div><br>
<p></p><div><br>
<div><b>The Agency's mission is to be boldly innovative in improving the health and quality of life for South Caro</b><b>linians.</b></div><div></div><div><br>
This position is located in <b>Eligibility, Enrollment and Member Service (EEMS) Processing Centers, Spartanburg County.</b><br>
This is an in-office role and not a telecommute or remote position.</div><div><br>
<b>
Are you the One? </b>We are looking for an <b>Eligibility Specialist II (LTCW)</b> who is the front-line of beneficiary access to the Medicaid program. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists ensure the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner. In addition to meeting minimum standards for timely determinations in accordance with the Department&rsquo;s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team.</div><ul><li>
Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists.</li><li>
Demonstrates proficiency in utilizing all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately in the appropriate systems of record.</li><li>
Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.</li><li>
Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.</li></ul><div><b>
The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:</b></div><ul><li>
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.</li><li>
15 days annual (vacation) leave per year.</li><li>
15 days sick leave per year.</li><li>
13 paid holidays.</li><li>
State Retirement Plan and Deferred Compensation Programs.</li></ul></div><br>
<p></p>
<div><h2 class="jobSectionHeader"><b>Minimum and Additional Requirements</b></h2></div>
<p></p><div><p>A high school diploma and experience in customer services, social services, human services, and/or Medicaid processing.</p><p>
A bachelor's degree may be substituted for the required program experience.</p><p><b><br>
Additional Requirements:</b></p><ul><li>
Overtime and/or weekend work with Deputy approval.</li><li>
Sitting or standing for long periods of time.</li><li>
Lifting requirements: 20 lbs.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Preferred Qualifications</b></h2></div>
<p></p><div><ul><li>Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.</li><li>
Must be able to perform basic mathematical computations.</li><li>
Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.</li><li>
Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.</li><li>
Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.</li><li>
Demonstrates high performance standards.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Additional Comments</b></h2></div>
<div><p>Please complete the State application to include all current and previous work history and education. <b>A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes.</b><b> </b>All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.<br>
<br>
<i>The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.</i></p></div></div></div>

Eligibility Specialist II (LTCW) / 61059453

State of Washington

<div><div><div><h2 class="jobSectionHeader"><b>Description</b></h2></div>
<p></p><div><p><b>Medical Assistance Specialist 3 (MAS3/AHSO) - Quincy</b></p><p><b>
71036541</b></p><p><i>
This position is based out of the Quincy Community Health Center in Quincy, WA.</i></p><p>
This position works a hybrid schedule based out of the Quincy Community Health Center to determine individual and family eligibility for Washington State medical assistance programs. Within the Apple Health Services and Operations (AHSO) Division, this position supports the Health Care Authority (HCA) mission to provide access to medical care for all eligible Washington citizens.</p><p><i>
All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes</i>.</p><p><b>
About the division:</b></p><p>
The Apple Health Services and Operations (AHSO) Division works across the Health Care Authority (HCA) and in partnership with the health care community at local, state and federal levels, in order to develop, and manage high quality, and evidence-based health care programs and purchase services that enhance Washington State&rsquo;s citizens&rsquo; ability to access appropriate, quality health care.</p><p><b>
About the position:</b></p><p>
This position supports the HCA mission to provide access to medical care for all eligible Washington citizens. The position determines initial eligibility and/or ongoing individual and family medical eligibility for Medicaid Title XIX, Children&rsquo;s Health Insurance Program (CHIP) Title XXI program, and other Medicaid and state funded medical assistance programs available in Washington State.</p><p><b>
This position is eligible to telework but is typically required to report on-site three days per week in the Quincy Community Health Center. This expectation may increase or decrease depending on the facility&rsquo;s needs. </b>The default assigned work location of all Health Care Authority (HCA) positions &ndash; both on-site and telework eligible positions &ndash; is within the State of Washington. This position reports to Quincy, WA. Frequency of onsite work will vary based on business and operational needs. <b>HCA has currently suspended the ability to support out-of-state telework.</b></p></div><p></p>
<div><h2 class="jobSectionHeader"><b>Duties</b></h2></div>
<p></p><div><p><b>Some of what you will do:</b></p><ul><li>
Independently determine initial and/or ongoing eligibility for Health Care Authority Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state funded medical assistance programs administered by the MEDS office.</li><li>
Apply complex federal and state eligibility regulations published in WAC and RCW to specific household circumstances resulting in accurate eligibility decisions.</li><li>
Use and manage multiple interdependent electronic systems including Automated Client Eligibility System (ACES), HealthPlanFinder, ProviderOne, Audit Plus, Microsoft Office, SOLQ, Document Management System (DMS), and Employment Security Department (ESD).</li><li>
Analyze, research, and resolve complex eligibility issues applying proper rules and procedures with a high degree of independence.</li><li>
Conduct interviews over the telephone, in person, and/or through written correspondence with clients, providers and/or third parties to obtain information for required documentation and verification to support program eligibility. Establish effective working relationships with clients and their advocates and manage difficult interactions with tact and diplomacy.</li><li>
Work with individual Take Charge providers to answer inquiries and resolve issues related to eligibility for the Take Charge Family Planning program.</li><li>
Answer inquiries, resolve questions, update eligibility records and otherwise maintain and expand access to medical care for eligible Washington citizens.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Qualifications</b></h2></div>
<p></p><div><p><b>Required qualifications:</b></p><p>
Qualifying candidates will meet <b>one</b> of the following criteria options:</p><p>
Option 1:</p><ul><li>
Bachelor&rsquo;s degree and</li><li>
One year of the qualifying experience as defined below.</li></ul><p>
Option 2:</p><ul><li>
Associate degree and</li><li>
Three years of the qualifying experience as defined below.</li></ul><p>
Option 3:</p><ul><li>
Completion of a Certificate of Medical Billing and Coding, or closely related certificate program and</li><li>
Three years of the qualifying experience as defined below.</li></ul><p>
Option 4:</p><ul><li>
Five years of the qualifying experience as defined below.</li></ul><p>
Option 5:</p><ul><li>
One year as a Medical Assistance Specialist 2.</li></ul><p>
Qualifying experience for this position is defined as:</p><ul><li>
Providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits;</li><li>
public assistance eligibility determination;</li><li>
health insurance premiums/claims processing, adjusting, and investigation;</li><li>
other medical premiums/claims/eligibility related experience; or</li><li>
experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone.</li></ul><p><b>
Required competencies:</b></p><ul><li>
The ability to take action to learn and grow.</li><li>
The ability to take action to meet the needs of others.</li></ul><p><b>
Preferred qualifications:</b></p><ul><li>
Experience performing conflict resolution with customers.</li><li>
Knowledge of Medicaid programs and eligibility.</li><li>
Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint.</li></ul><p><b>
How to apply:</b></p><p>
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. <b>To apply for this position, you will need to complete your profile which includes three professional references and attach in separate files:</b></p><ul><li>
A <b>cover letter</b> that specifically addresses how you meet the qualifications for this position</li><li>
Current <b>resume</b></li></ul><p>
To take advantage of <b>veteran preference</b>, please do the following:</p><ul><li>
Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.</li><li>
Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Supplemental Information</b></h2></div>
<p></p><div><p><b>About HCA:</b></p><p>
Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.</p><p>
There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.<br>
<br>
<b>What we have to offer:</b></p><ul><li>
Meaningful work with friendly co-workers who care about those we serve Voices of HCA</li><li>
A clear agency mission that drives our work and is person-centered HCA's Mission, Vision &amp; Values</li><li>
A healthy work/life balance, including alternative/flexible schedules and mobile work options.</li><li>
A great total compensation and benefit package WA State Government Benefits</li><li>
A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.</li><li>
And free parking!</li></ul><p><b>
Notes:</b></p><p>
This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.</p><p>
Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.</p><p>
HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA&rsquo;s mission.<i> </i>Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at jake.nelko@hca.wa.gov or 360.725.0945.</p><p>
The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.</p><p></p><p>
E-Verify&reg; is a registered trademark of the U.S. Department of Homeland Security.</p><p></p><p>
Subscribe to our weekly newsletter to receive a list of new job postings at HCA.</p></div></div></div><p></p>

Medical Assistance Specialist 3 (MAS3/AHSO) - Quincy

Oregon Health & Science University

<div>Department Overview:
<p>
The purpose of this position is to secure reimbursement for services rendered to uninsured and/or underinsured patients by assisting individuals in accessing and/or applying for any Medicaid or other Federal or State assistance programs, or for other forms of sponsorship for which they might qualify. The result of this activity is new and continued reimbursement for medical care services. Performs requirements for staff members as outlined in Compliance Roles and Responsibilities in OHSU Hospitals and Clinics.</p>
Function/Duties of Position:
<ul><li>Conducts on-site Medicaid program intakes in both English and Spanish, forwarding applications and supporting documentation to appropriate Medicaid office, Aging and People with Disabilities office (APD), and other state Department of Human Services (DHS) offices as appropriate.</li><li>
Assists potential eligible clients or their representatives in the application process with the appropriate public assistance office, monitoring, advising, interviewing and advocating as appropriate throughout the application process from initial application through formal decision.</li><li>
Monitors decisions of approval to ensure accuracy of program and medical effective date and decisions of denial assuring appropriateness of agency action.</li><li>
Counsels referred patients delineating State medical coverage versus personal liability.
</li><li>Assesses patients for waivered or placement services, coordinating the process with OHSU Care Management, Medicaid agency staff and providers of the waivered services or nursing home placement staff for successful and timely discharges for inpatients and service plan and placements post discharge.</li><li>
Evaluates and advises patients and family members in accessing hospital and community services by consulting and making referrals to social workers, patient care coordinators, nursing home liaisons, outside agencies and legal services.</li><li>
When information gathered discloses that a patient has insurance, gathers information, codes and transfers account to the Insurance Verification Specialists for insurance verification and authorization.</li><li>
For patients/guarantors disclosing difficulty in paying their bill, and after assessing all other possible funding sources such as COBRA, Medicaid, etc., initiates application under the OHSU Financial Allowance Policy.</li><li>
Provides assistance to other internal and external eligibility staff and to miscellaneous hospital staff regarding Oregon Medicaid programs administered through DHS; provides interpretation of the state&rsquo;s DHS computer screens; provides assistance regarding programs of the Social Security Administration.</li><li>
Provides assistance related to managed care, indemnity plans, Medicare and other insurance plans.</li><li>
Actively identifies, on a continuous basis, Medicaid program changes, problematic policy issues and procedural requirements relative to state and federal programs that impact patients and the hospital.
</li><li>Other duties as assigned.</li></ul>
Required Qualifications:
<ul><li><p>
A minimum of one year of recent experience in determining Medicaid eligibility; <b>OR</b></p></li><li><p>
Three years of any combination of determining eligibility for public assistance programs. Recent experience is defined as within the last five years.</p></li><li><p>
An undergraduate degree will substitute for one years of Medicaid experience.</p></li><li><p>
Preference is given to applicants who have experience determining eligibility for Medicaid applicants/recipients.</p></li></ul><p><b>
Knowledge, Skills, and Abilities</b></p><ul><li>
Extensive knowledge of statutes, regulations, policies, procedures and guidelines of assistance programs administered by DHS agencies and the Social Security Administration as well as community programs available to patients in need.</li><li>
Extensive knowledge regarding confidentiality, privileged communication and professional ethics, including advocacy techniques.</li><li>
Extensive knowledge of the Medicaid eligibility systems and other information systems, personal computers and office equipment. Knowledge of medical terminology.</li><li>
Skill in interpreting and applying Federal &amp; State rules and regulations, policies and procedures for Medicaid, disability programs &amp; Health Insurance Portability and Accountability Act (HIPAA).</li><li>
Skill in casework methods and techniques including communication with and assessing the needs of individuals with physical and mental disabilities, the elderly and disease processes.</li><li>
Skill in verbal and written communication with patients/clients and collateral resources of various socioeconomic backgrounds.</li><li>
Skill in prioritizing and managing work time and efforts to accomplish both ongoing and emergent duties. Skill in maintaining composure and working objectively with patients/clients who may be hostile or verbally abusive.</li><li>
Skill in maintaining harmonious working relationships.</li><li>
Must have demonstrable record of reliable attendance, exemplary customer contact skills, punctuality, and proven successful performance at most recent past and present employers.</li></ul><p><b>
Certifications</b></p><ul><li><p>
Must complete certification as a Medicaid Application Assister (for both Oregon and Washington) within 3 months of employment, which includes a background check through the State of Oregon. Must be able to maintain certification annually.</p></li><li><p>
Certificate of Successful completion in Spanish Language, issued by OHSU Translation and Interpreter Services Department&rsquo;s current process.</p></li></ul>
Preferred Qualifications:
<ul><li>Undergraduate Degree.</li><li>
A minimum of three years of recent experience in determining Medicaid eligibility.</li></ul>
Additional Details:
<p>
Hybrid remote, Monday - Friday, 9:30am - 6:00pm. Work from home days must be Tuesdays, Wednesdays, or Thursdays.</p><p></p><p><br>
Regular contact with patients both in office and in a clinical setting.</p><p>
Occasional contact with hostile or angry patients or family members.</p><p></p><p><b><br>
Benefits</b></p><ul><li><p>
Healthcare for full-time employees covered 100% and 88% for dependents.</p></li><li><p>
$50K of term life insurance provided at no cost to the employee.</p></li><li><p>
Two separate above market pension plans to choose from.</p></li><li><p>
Vacation - up to 200 hours per year dependent on length of service.</p></li><li><p>
Sick Leave - up to 96 hours per year.</p></li><li><p>
9 paid holidays per year.</p></li><li><p>
Substantial Tri-Met and C-Tran discounts.</p></li><li><p>
Employee Assistance Program.</p></li><li><p>
Childcare service discounts.</p></li><li><p>
Tuition reimbursement.</p></li><li><p>
Employee discounts to local and national businesses.</p></li></ul>
Why apply to OHSU?: <b>We are Oregon's only public academic health center.</b> In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. <b>All are welcome.</b> OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu</div>

Medicaid Specialist

Cibola General Hospital

<div>Description:
<p>
 <b>Job Summary</b></p><p>
Cibola General Hospital is seeking a Patient Financial Counselor / Presumptive Eligibility Determiner to assist uninsured and underinsured patients in accessing healthcare coverage and financial assistance programs.</p><p>
This position conducts Medicaid Presumptive Eligibility screenings, assists patients with Medicaid applications, and provides financial counseling regarding payment options and financial assistance programs. The role works closely with patients, clinical staff, and revenue cycle teams to ensure patients receive timely access to medically necessary services.</p><p><b>
Responsibilities</b></p><ul><li>
Assist patients in completing Medicaid applications through the YES-NM portal</li><li>
Provide financial counseling and discuss payment options with patients</li><li>
Identify patients who may qualify for Medicaid or hospital financial assistance programs</li><li>
Document patient encounters and eligibility determinations in the electronic health record (EHR)</li><li>
Work with clinical staff and internal departments regarding eligibility determinations and follow-up</li><li>
Ensure compliance with HIPAA, Medicaid guidelines, and hospital policies</li><li>
Provide excellent customer service to patients and families</li></ul>
Requirements:
<p>
 <b>QualificationsRequired</b></p><ul><li>
High School Diploma or equivalent</li><li>
Strong communication and customer service skills</li><li>
Basic computer skills and ability to learn healthcare systems</li><li>
Ability to maintain confidentiality and handle sensitive patient information</li></ul><p><b>
Preferred</b></p><ul><li>
Experience in healthcare billing, registration, or revenue cycle</li><li>
Experience with Medicaid eligibility or financial assistance programs</li><li>
Previous hospital or healthcare experience</li></ul><p><b>
Certification</b></p><p>
Presumptive Eligibility Determiner certification required or must be obtained within the timeframe required by the New Mexico Human Services Department.</p><p><b><br>
Work Environment</b></p><ul><li>
Office setting within a hospital environment</li><li>
Frequent interaction with patients, families, and healthcare staff</li></ul></div>

Patient Financial Counselor

HCA Florida West Hospital​

<p></p><div><p><b>This Work from Home position requires that you live and will perform the duties of the position; within the state of Florida.</b></p><p></p><p>
Do you want to join an organization that invests in you as a Medicaid Eligibility Advocate? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.</p><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5>
<p></p><h5 class="jobSectionHeader"><p><b>The Medicaid Eligibility Advocate is responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Medicaid Eligibility Advocate serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management.</b></p><p></p><p><b>
In this role you will:</b></p><p></p><ul><li><b>
Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity applications.</b></li><li><b>
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.</b></li><li><b>
Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.</b></li><li><b>
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.</b></li><li><b>
Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient&rsquo;s file and the hospital computer system.</b></li><li><b>
Participates in ongoing, comprehensive training programs as required.</b></li><li><b>
Follows policies and procedures to contribute to the efficiency of the office. Covers and assists with other office functions as requested.</b></li><li><b>
Will be required to make field visits as necessary and will need reliable personal transportation readily available.</b></li></ul><p></p><p><b>
Qualifications:</b></p><ul><li><b>
Associate&rsquo;s degree preferred</b></li><li><b>
Minimum one-year related experience preferred, preferably in healthcare.</b></li><li><b>
Relevant education may substitute experience requirement.</b></li></ul><b>
Benefits</b></h5><p></p><p>
Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li><b>
Comprehensive benefits</b> for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li><b>
Wellbeing support,</b> including free counseling and referral services</li><li><b>
Time away from work</b> programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li><b>
Savings and retirement resources</b>, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li><b>
Education support</b> through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li><b>
Additional benefits</b> for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.</i></b></p><p>
&quot;</p><p><b>
Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p>
&quot;</p><br>
<p></p><p>&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p><p>
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Medicaid Eligibility Advocate opening. Qualified candidates will be contacted for interviews. <b>Submit your resume today to join our community of caring!</b></p><p><i>
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Medicaid Eligibility Advocate

Talent Portus

<p><b>Position &ndash;</b> <b>Adoption Eligibility Specialist</b><br/><b>Location &ndash; Onsite in Indianapolis, IN 46204</b><br/><b>Duration &ndash; 12+ Months Contract </b><br/><b>Visa &ndash; All Visa </b><br/><b>Client &ndash; State of IN</b></p><p><b>Description:</b></p><p>Works as professional staff within the Department of Child Services Central Eligibility Unit performing multiple adoption eligibility tasks</p><p><b>The essential functions of this role are as follows: </b></p><p>&middot; Works as professional staff within the Department of Child Services Central Eligibility Unit performing multiple adoption eligibility tasks such as reviewing and processing status reports, Preparing NRAE packets, making copies as requested, managing electronic files, open and appropriately distribute mail, and preparing adoption finalization packets.</p><p>&middot; Reviews and prepares various files for completion such as adoption payment files.</p><p>&middot; Answers inquiries from adoptive parents concerning case status.</p><p>&middot; Completes activities while ensuring compliance with applicable federal and state policies and procedures.</p><p>&middot; The position may also determine Title IV-E (Foster Care and Adoption Assistance) program eligibility based upon defined federal and state regulations, policies, and procedures.</p><p>&middot; interprets and analyzes fiscal data and other information about children and families to enhance and maintain the Department's various federal and state funding recoveries.</p><p>&middot; It may require interaction with Family Case Managers, supervisors, and Local Office Directors to request and clarify information when making determinations.</p><p>&middot; This role requires effective verbal and written communication skills.</p><p>The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.</p><p><b>Required/Desired Skills</b></p><p>High school Diploma - Required</p><p>Prior experience in an administrative assistant position, at least 2 years consecutive duration in same position. - Required - 2 Years</p><p>Working knowledge of Microsoft Word, Outlook, PowerPoint and Excel - Required</p><p>Effective written and verbal communication skills. - Required</p><p>Attention to detail and proofreading skills. - Required</p><p>Organizational skills with the ability to prioritize tasks effectively and multitask - Required</p><p>Previous experience in a position that demanded a high level of confidentiality. - Highly desired</p><p>Working knowledge of MaGIK and/or KidTracks - Desired</p><p>Knowledge of federal and state regulations related to child services and adoption eligibility. - Desired</p><p>Pay: $25.00 - $26.00 per hour</p><p>Benefits:</p><ul><li>Professional development assistance</li></ul><p>Work Location: In person</p>

Adoption Eligibility Specialist

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