Medicaid Eligibility Quality Assurance Specialist

Work From Home; Nashville (TN); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Comprehensive benefits

Wellbeing support

Time away from work

401(k) Plan with 100% match on 3% to 9

Education support

Fertility and family building

Job summary

Parallon is seeking a Medicaid Quality Eligibility Specialist to support Medicaid eligibility operations on a remote basis. You will perform QA, analyze data to support decision-making, and document QA steps for audit trails across multiple departments.

Requirements include a minimum of 3 years in Medicaid Eligibility and proficiency with Microsoft Office, especially Excel and Word. A reliable home-office setup with high-speed internet is required to maximize revenue and improve processes within

Qualifications

• Minimum of 3 years’ experience within Medicaid Eligibility, preferably as both a hospital-based screener and an application processor.
• Experience with standard suite of Microsoft office software products.
• Intermediate to advanced proficiency with Excel and Word.
• Work from home roles require employees must have high speed internet 60 MB download and 10 MB upload.

Responsibilities

• Perform quality assurance activities for Medicaid eligibility operations to ensure that work efforts satisfactorily meet customer requirements in a systematic, reliable fashion, effectively using systems to do so.
• Perform analytical assessments of data and assist the management team in using the data for decision‑making purposes.
• Maintain prompt and accurate documentation outlining all steps of the QA program that have been taken in individual organized files.
• Audit the assigned number of accounts per day following a set schedule. Forms will be completed and submitted within required timelines.
• Work independently with various departments to ensure revenue is maximized.
• Maintain reports that are indicative of process improvement within departments while promoting a positive presence in improving these processes.
• Make recommendations based on assessments that improve production and quality.
• Ability to multi-task to ensure day-to-day work is complete as well as assigned projects.
• Coordinate QA findings with appropriate departments, internal or external, and ensure that necessary follow up is done to resolve any negative results.
• Provide documented results and process improvement to Director for departments not meeting company/client standards.
• Perform special projects or other activities as assigned. Establish and maintain constructive working relationships with coworkers, supervisors, managers and executives, as well as external clients and other external business contacts.

Tools

Microsoft Office

Excel

Word

Job description

Schedule ; Mon -Fri - 7:30 am -4:30 pm

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Job Summary and Qualifications

In this role you will:

• Must have 3 years of Medicaid eligibility Advocate experience
• Perform quality assurance activities for Medicaid eligibility operations to ensure that work efforts satisfactorily meet customer requirements in a systematic, reliable fashion, effectively using systems to do so.
• Perform analytical assessments of data and assist the management team in using the data for decision‑making purposes.
• Maintain prompt and accurate documentation outlining all steps of the QA program that have been taken in individual organized files. Complete the proper forms. Audit the assigned number of accounts per day following a set schedule. Forms will be completed and submitted within required timelines.
• Work independently with various departments to ensure revenue is maximized.
• Maintain reports that are indicative of process improvement within departments while promoting a positive presence in improving these processes.
• Make recommendations based on assessments that improve production and quality.
• Ability to multi-task to ensure day-to-day work is complete as well as assigned projects.
• Coordinate QA findings with appropriate departments, internal or external, and ensure that necessary follow up is done to resolve any negative results.
• Provide documented results and process improvement to Director for departments not meeting company/client standards.
• Perform special projects or other activities as assigned. Establish and maintain constructive working relationships with coworkers, supervisors, managers and executives, as well as external clients and other external business contacts.

Qualifications

• Minimum of 3 years’ experience within Medicaid Eligibility, preferably as both a hospital-based screener and an application processor.
• Experience with standard suite of Microsoft office software products.
• Intermediate to advanced proficiency with Excel and Word required.
• Work from home roles require employees must have high speed internet 60 MB download and 10 MB upload.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefitsfor medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support,including free counseling and referral services
• Time away from workprograms for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, 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
• Education supportthrough tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefitsfor fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Parallon 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.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® 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.

If you find this opportunity compelling, we encourage you to apply for our Medicaid Quality Eligibility Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team.

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.