Interviews uninsured/under-insured patients in a hospital setting to determine eligibility for State Medicaid benefits and Financial Assistance
Requires assisting patients in hospital rooms with the application processes to facilitate accurate and appropriate application submission
Requires building a positive relationship with the patient and communication of the eligibility process and the benefits of having Medicaid coverage
Oversight of signatures on State forms and clear communication regarding the additional documents the patient will need to provide to complete the application is central to this role

Minimum Education: High School Diploma or GED
Minimum years and type of experience: 1-2 years of experience in the healthcare industry, social work, or case management environment, interacting with patients regarding financial concerns, working with self-pay, underinsured, or a compromised population in a face-to-face customer service capacity proactively explaining complicated programs
Understanding of Revenue Cycle functions including billing, payments, denials, authorizations, and benefit verifications
Knowledge of health insurance requirements
Knowledge of medical terminology
Patient access experience with managed care/insurance knowledge
Ability to comprehend various state Medicaid plan qualifications and communicate patient benefits clearly and effectively to those most likely to benefit
Good math skills and ability to identify best program for an applicant out of those available
Complete written applications with patients to submit to state agencies and ensure the supporting documents will be provided timely
Customer service ability, strong face to face communication skills, background working with customers or patients on document completion and applications, knowledge of medical expenses and associated bills, knowledge of patient insurance, ability to multitask, ability to learn complex state requirements for programs and explain to patients, bias for action, patient/consumer-focused, entrepreneurial and commitment to excellence and service.

Inpatient Eligibility Specialist

Key skills