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Medicaid Eligibility Specialist (Patient Financial Resources)

Cone Health has a Medicaid Eligibility Specialist/Patient Financial Resources Specialist opportunity available in Reidsville, NC!
Cone Health is a state-of-the-art network of facilities and healthcare practitioners providing access to the latest developments in medical care.
At Cone Health, we emphasize "care" in both word and deed. Our caring behavior is central to our organizational culture and corporate citizenship.

BASIC PURPOSE:
This position is accountable for establishing acceptable financial arrangements on assigned patient accounts by way of securing sponsorship from various federal, state, and county agencies, in order to meet the patient's financial obligation to the Hospital and ensure reimbursement.

EDUCATION:
Required:
High School diploma or equivalent.
Required - Valid Driver's License:
If driving Cone Health vehicle, must have 5 years of driving experience and MVR must be approved by Risk Management.
Experience:
Required:
1 year customer service experience in a healthcare or related setting
Preferred:
6 months patient registration Medical Terminology
HIGHLY PREFER billing and collections experience for Medicaid. Medicaid eligibility and/or billing experience
KNOWLEDGE, SKILLS AND ABILITIES:
Required:
Able to independently design professional presentations suited for c-suite audience using high level of power point skills or other technology.
Able to research assigned topics and develop presentation materials aligned with topic.

MAJOR WORK ACTIVITIES (MWA'S):
1. Responsible for initial and follow-up contact for all patients admitted without sponsorship. Screen and counsel patients and/or their family regarding financial eligibility for possible assistance from various sponsoring federal, state, and county funded programs that provide reimbursement for medical expenses. (30%)
2. Gather patient medical history from hospitals, physicians' offices, and other treatment facilities' medical records and analyze documentation through comprehensive review to determine patient's medical eligibility for financial sponsorship from various federal, state, and county funded programs (20%)
3. Refer potentially eligible patients to appropriately determined sponsorship programs and coordinate the patients' application processes by serving as the patient advocate and hospital liaison to the funding agency from time of referral to the approval or denial. This includes facilitating collaborative efforts with other hospital departments such as Care Management, Insurance Verification, Medical Records and other areas of Patient Accounting to enhance patient financial counseling efforts for the achievement of maximum financial reimbursement to the Hospital. (10%)
4. Monitor funding agencies' application processing and authorization practices to ensure timely and accurate eligibility decisions. Follow-up with appropriate agencies as well as the patients to ensure required information is provided, appointments are kept, and Medical Records are received. When necessary, become appointed patient's representative in order to initiate and conduct pre-hearing and appeal processes as a sworn legal representative of the hospital and patient. Preparing a prehearing argument and presenting it before the Chief Hearing Officer if necessary to overturn an inappropriate sponsorship denial. (10%)
5. Assist insured patients with concerns regarding Hospital insurance benefits, to include providing recommendations regarding financial assistance for patients with less than 80% third party liability, monitoring Medicare in-house patients stay to insure timely cycle billing, as well as utilization review cutoff notifications and FL-2 forms. (20%)
6. Maintain acceptable level of quality and production standards as determined by supervisory review and audit of assigned account categories by maintaining reports and worklists provided daily. (10%)

To review the complete job description and apply online, please visit:
www.conehealth.com/careers (Select Requisition c8792) or Click "Apply Here"


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