Medicaid Eligibility Specialist

Med-Metrix; New York (NY); On-site; USD 42,000 - 64,000; Full time

Job summary

Med-Metrix is seeking a Medicaid Coordinator to support hospital clients by gathering and processing Medicaid applications for in-house and discharged patients. You will screen eligibility by phone, enroll patients, verify information, and maintain PHI in HIPAA-compliant systems.

Responsibilities include data entry, status tracking, and preparing reports in Excel, with a focus on accuracy and urgency to ensure prompt payment to hospitals.

Qualifications

• High School Diploma or equivalent is required.
• Bilingual English/Spanish is required.
• Experience with ePACES and LexisNexis is a plus.
• Experience in healthcare or insurance plans is a plus.
• Proficiency in Microsoft Office Suite is required.
• Strong investigatory and researching skills.
• Strong interpersonal and communication skills.

Responsibilities

• Call patients and screen for Medicaid eligibility on cases referred by client hospital over the phone.
• Enroll patients in health insurance coverage via Marketplace or by completing the paper application package to submit to HRA/Local Department of Services.
• Review, validate and process confidential information.
• Research and verify patient contact information using search engines and hospital computer systems.
• Research and resolve Medicaid-related issues.
• Send various automated letters to patients from the Firms database.
• Retrieve information from hospital databases.
• Verify insurance.
• Update the Firms internal database with all work done on an account (actions taken to communicate with patients, code, account).
• Track application status via the Marketplace and/or call LDSS/HRA for status.
• Keep track of the status of denied applications throughout the Fair Hearing process.
• Prepare and review reports on open accounts using Microsoft Excel.
• Schedule and coordinate meetings with patients.
• Manage calendars.
• Respond to requests for additional documents from Market Place/Department of Social Services.
• Use, protect and disclose patients protected health information (PHI) only in accordance with HIPAA standards.
• Understand and comply with Information Security and HIPAA policies and procedures at all times.
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Skills

Bilingual English/Spanish

Investigative & research

Administrative experience

Interpersonal skills

Written & verbal communication

Education

High School Diploma or equivalent

Tools

Microsoft Office Suite

ePACES

LexisNexis

Job description

Med-Metrix is seeking a Medicaid Coordinator to support hospital clients by gathering and processing Medicaid applications for in-house and discharged patients. You will screen eligibility by phone, enroll patients, verify information, and maintain PHI in HIPAA-compliant systems.

Responsibilities include data entry, status tracking, and preparing reports in Excel, with a focus on accuracy and urgency to ensure prompt payment to hospitals.