Medicaid Program Specialist, Financial Counseling

40 hours per week, day shift

JOB SUMMARY:  Responsible to assure that each potential Medicaid candidate receives a thorough and accurate financial and clinical assessment to determine Medicaid or NC Health Choice eligibility. Executes the application process or makes referral to the appropriate Department of Social Services or the Social Security Administration (SSA) office. Facilitates the financial assistance needs of those found to be ineligible for Medicaid, NC Health Choice or Social Security Disability (SSD) by identifying the patient's eligibility for Community Benefits or other state, federal or internal assistance programs when indicated. 

EDUCATION/EXPERIENCE: High school diploma with two years as a Social Services Income Maintenance Caseworker or three years' experience in a clinic or hospital based Financial Counseling/Medicaid referral department/unit required. Bachelor's degree in Business or Human Services preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: N/A

ESSENTIAL FUNCTIONS:

1. Evaluates financial statements and other relevant documents sent from all referral sources to determine the patient's eligibility for assistance through a Medicaid program and/or Charity Care. Refers for state agency assistance when appropriate.

2. Contacts physicians and/or other clinicians to discuss and/or establish the patient's long-term length of disability when required for adult Medicaid program assistance. Reviews and assesses the patient's medical record to validate the disability requirement based on Social Security Disability guidelines.

3. Meets with patients/families to scrutinize the financial information for accuracy and to obtain other specific information needed to determine Medicaid eligibility.

4. Assures that self-pay patients who are scheduled for services are financially and clinically evaluated as quickly as possible for Medicaid eligibility.

5. Communicates with key individuals in the discharge planning arena to assure that Medicaid coverage has been discussed and/or executed for those patients requiring placement at a lower level of care facility.

6. Provides specific direction and guidance to patients or other individuals as it relates to the Medicaid application and Social Security Disability (SSD)/Supplemental Security Income (SSI) application processes. Identifies and resolves roadblocks related to excess reserve as quickly as possible to assure the patient's eligibility for the Medicaid Program and to maximize reimbursement opportunities for the medical center.

7. Keeps current and follows specific Medicaid application guidelines and rules as outlined in the Federal Regulations, Medicaid Manual, Social Security regulations and general statutes for the various states whose residents we serve and refer for assistance.

8. Completes Medicaid application when applicable and assures mailing to the Department of Social Services within the time frame which will assure coverage for the patient's medical bills incurred.

9. Acts on patient's behalf when the required documents have been signed and are on file. Follows-up with the patient to assure that they have complied with instructions to apply for the appropriate program in the month requested.

10. Assures that patients who apply for adult Medicaid programs also apply for Social Security (SSA) by setting up the initial SSA interview.

11. Assures that documentation related to the Medicaid referral/application are scanned and thoroughly documented in the medical center's patient accounting system(s).

12. Completes the Community Benefits eligibility process on patients found not to be eligible for Medicaid when appropriate.

SKILLS/QUALIFICATIONS:

• Excellent oral, written, listening, and interpersonal communication skills
• Possesses strong interpretive communication and interviewing skills
• Ability to execute discretion, vital decision-making and independent judgment under stressful conditions
• Must have an applied and enhanced knowledge and understanding of medical diagnoses and prognoses
• Ability to read, interpret and execute written guidelines, rules and laws in the Medicaid Manual for NC and other states, Social Security Disability Guidelines and the Federal Code of Regulations when necessary
• Uses strong background and work experience with financial statements for the purpose of determining eligibility for Adult and Family Medicaid programs, state program assistance, Community Benefits or COBRA
• Ability to work independently in conjunction with strong organizational and time management skills
• Detail-oriented and possesses strong analytical and problem-solving skills
• Possesses strong mathematical and multi-tasking skills
• Flexible as it pertains to work location and hours when applicable and/or required

WORK ENVIRONMENT:

• Clean well-lit and comfortable climate
• Moderate to loud noise environment depending on work location
• Fast-paced environment
• Subject to many interruptions
• Occasional to frequent stress due to job subject matter

PHYSICAL REQUIREMENTS:

0% 35% 65%

to to to

35% 65% 100% N/A Activity

X Standing

X Walking

X Sitting

X Bending

X Reaching with arms

X Finger and hand dexterity

X Talking

X Hearing

X Seeing

Lifting, carrying, pushing and or pulling:

X 20 lbs. maximum

X 50 lbs. maximum

X 100 lbs. maximum