What are the responsibilities and job description for the Medicaid Eligibility Representative position at White Rock Medical Center?
Description
- Screen patients for Medicaid and other government program eligibility at bedside, registration, or via telephone.
- Complete and submit Medicaid applications accurately and timely in accordance with state and federal guidelines.
- Obtain and verify required documentation including income, residency, citizenship, disability, and household information.
- Educate patients and families on Medicaid benefits, eligibility requirements, and application processes.
- Act as liaison between patients, hospital departments, and state Medicaid offices.
- Track application status, follow up on pending cases, and resolve denials or requests for additional information.
- Document all eligibility activities in the hospital’s electronic health record (EHR) and eligibility systems.
- Collaborate with Patient Access, Case Management, Social Services, and Billing departments to ensure continuity of coverage.
- Ensure compliance with HIPAA, CMS regulations, and hospital policies.
- Meet productivity and quality benchmarks related to application approvals and turnaround times.
- Assist with audits, reporting, and performance improvement initiatives related to Medicaid eligibility.
- Maintain up-to-date knowledge of Medicaid policy changes and eligibility criteria.
- Minimum of 2-3 years' experience in Medicaid eligibility, patient access, financial counseling, or healthcare registration
- Knowledge of Medicaid eligibility rules and application processes
- Proficiency with electronic eligibility systems and EHR platforms
- Strong attention to detail and documentation accuracy
- Excellent verbal and written communication skills
- Ability to handle sensitive financial and personal information with discretion
- Strong customer service and patient advocacy skills
- Associate’s degree or higher in healthcare administration, social services, or related field
- Hospital or acute care experience
- Experience with state Medicaid portals and verification tools
- Bilingual (English/Spanish) preferred
- Familiarity with CMS, SSI, disability Medicaid, and emergency Medicaid programs