Eligibility Specialist, FT, 1st shift

Overview

Primary Responsibilities:

• Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and determine eligibility for public assistance programs and services for all service types for self-pay and Medicare only
• Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
• Monitors on-going eligibility by obtaining periodic updated information of eligibility factors and takes appropriate actions on changes
• Manages, organizes and prioritizes caseload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
• Prepares Daily and Monthly reports accurately and timely as requested by Revenue Cycle Director and/or CFO
• Awards Hospital Presumptive Eligibility in accordance with The Alabama Medicaid Agency
• Preforms diligent follow up with patients, attorneys and appropriate Medicaid agency caseworker throughout process
• Documents CPSI account progress accurately and timely
• Compiles evidentiary requirement for patients applying for disability
• Interacts with attorneys involving disability claims and Alabama Medicaid Agency to build positive work relations
• Expedite active Medicaid Number to billers and payment follow up for rejection errors
• Troubleshoot and resolve issues daily with Eligibility Programs Manager
• Responds to all emails and voicemails within 48 hours

Qualifications

This position requires, at minimum, a high school diploma or GED. Associate’s or Bachelor’s degree in a field related to healthcare billing, business, or a related field is preferred.  Prior experience in the healthcare environment and/or customer service is preferred.  A working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook are necessary.  This position requires the ability to communicate in a pleasant, professional, concise, and caring manner. It also requires critical thinking and problem solving to ensure the best care possible for our patients.

About Us

Position Summary:  The Eligibility Specialists screen private pay patients for various state and federal programs to assist with paying their medical bills.  Primarily, they screen and award patients with Hospital Presumptive Eligibility through certification from Alabama Medicaid. They also direct patients to other program and financial assistance when appropriate. 

Primary Responsibilities:

• Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and determine eligibility for public assistance programs and services for all service types for self-pay and Medicare only
• Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
• Monitors on-going eligibility by obtaining periodic updated information of eligibility factors and takes appropriate actions on changes
• Manages, organizes and prioritizes caseload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
• Prepares Daily and Monthly reports accurately and timely as requested by Revenue Cycle Director and/or CFO
• Awards Hospital Presumptive Eligibility in accordance with The Alabama Medicaid Agency
• Preforms diligent follow up with patients, attorneys and appropriate Medicaid agency caseworker throughout process
• Documents CPSI account progress accurately and timely
• Compiles evidentiary requirement for patients applying for disability
• Interacts with attorneys involving disability claims and Alabama Medicaid Agency to build positive work relations
• Expedite active Medicaid Number to billers and payment follow up for rejection errors
• Troubleshoot and resolve issues daily with Eligibility Program Manager
• Responds to all emails and voicemails within 48 hours

Education/Certification/Experience/Skills

This position requires, at minimum, a high school diploma or GED. Associate’s or Bachelor’s degree in a field related to healthcare billing, business, or a related field is preferred.  Prior experience in the healthcare environment and/or customer service is preferred.  A working knowledge of computers and systems to include Microsoft Word, Excel, and Outlook are necessary.  This position requires the ability to communicate in a pleasant, professional, concise, and caring manner. It also requires critical thinking and problem solving to ensure the best care possible for our patients.