Eligibility Specialist - Medicaid

UNC Health Care; Hendersonville (NC); On-site; USD 42,000 - 54,000; Full time

Job summary

UNC Health Care seeks a Medicaid/SSI eligibility specialist to help indigent patients obtain coverage by guiding them through the Medicaid application process from submission to award or denial. The role requires navigating complex program rules and reconciling information with strict timelines.

The position involves representing UNC Health Care in state and local appeal hearings, advocating for patient coverage and coordinating with the Patient Accounting team to ensure timely reimbursement.

Qualifications

• Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).
• Two years of experience in a social services or healthcare organization.
• Experience working with data and preparing reports.
• Strong written and verbal communication skills.

Responsibilities

• Obtains detailed personal, financial and asset information to determine patient eligibility and completes Medicaid application.
• Explains the programs and advises patients on methods to become eligible by rearranging finances and assets.
• Follows through with applicants to obtain accurate and complete information within strict timeframes.
• Represents UNC Health Care System in appeal hearings at local, state offices and courts to pursue reversal of initial denial.

Skills

Strong Written and Verbal Communicatio

Experience with data and reporting

Two years experience in social service

Education

Associate's degree or equivalent

Job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions are expected and entrusted to represent the organization at each of the four levels of appeals when applications are denied.

Responsibilities:

• Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application.
• Explains the programs and advises patients of methods to become eligible by rearranging finances and assets.
• Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs.
• Interprets and applies frequent changes in program regulations to expedite applications. 2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial.
• Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient's denial reversal

Other information:

Required Qualifications

• Associate's degree in an appropriate discipline (or equivalent combination of education, training and experience).
• Two (2) years of experience in a social services or healthcare organization.
• Experience working with data and preparing reports
• Strong Written and Verbal Communication skills.

Preferred Qualifications

• Spanish language fluency

Job Details

Legal Employer: Pardee - HCHC

Entity: Pardee UNC Health Care

Organization Unit: Patient Accounting

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: PARDEEHOSP

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.