Eligibility Specialist
Adreima - New Jersey

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The Eligibility Specialist is responsible for assisting hospital patients with the completion of the application process for any applicable governmental medical assistance programs. The Eligibility Specialist not only acts as an advocate for the patient, but also serves as a liaison to other Team members and to client hospital and government agency staff in a collaborative effort to facilitate eligibility coverage for incurred medical expenses.

Summary of Essential Job Duties:
Application Process & Determining Eligibility
Review referrals and screen for potential eligibility
Contact patient or their representative ASAP to complete the application and acquire all necessary releases, signatures, documents (including the birth certificate), etc.
Submit the application and any acquired documentation in a timely manner to the appropriate agency
Advise the applicant of all additional required documentation needs and time frames for compliance
Thoroughly enter all actions taken in the hospital account and in the internal data base/system
Follow-up & Monitoring
Maintain structured and timely contact with the applicant and responsible government agency, by phone whenever possible
Assist the applicant with gathering any additional reports or records, meeting appointment dates and times and arrange transportation if warranted
Conduct home visits as needed to acquire documentation
As per established protocols, inform the client in a timely manner of all approvals and denials of coverage
Thoroughly enter all actions taken in the hospital account and in the internal data base/system
Policy and Compliance
Participate in and complete all necessary job related in service training and continuing educational opportunities in order to maintain a leading-edge knowledge
Adhere to HIPAA rules of compliance
Understand, refer to, and comply with governmental policy related to program requirements for applicants

Minimum Qualifications:
Requires 3 to 5 years of related experience.
Experience in hospital business office and/or Medicaid casework is highly desirable.
Knowledge of Government eligibility program requirements is highly desirable.
Excellent communication skills, both verbal and written, with the ability understand users' questions and effectively disseminate technical information is essential.
Computer data entry or word processing skills and ability to operate routine office equipment are required.
Working knowledge of computer programs, i.e., Microsoft Excel®.
Must be able to type at least 30 wpm.
Needs to have a valid driver's license
Proof of Auto insurance coverage

Adreima - 19 months ago - save job - block
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Adreima specializes in assisting hospitals maximize reimbursements while decreasing demands on in-house staff. Our Receivables Management...