What are the responsibilities and job description for the Medicaid Eligibility Specialist position at Prime Healthcare?
About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 51 hospitals and more than 360 outpatient locations in 14 states, providing over 2.5 million patient visits annually. It is one of the nation's leading health systems, with nearly 57,000 employees and affiliated physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity.
We are seeking a detail-oriented and compassionate Medicaid Eligibility Specialist with hands-on experience in Illinois Medicaid programs. The ideal candidate will be responsible for screening, determining, and verifying patient eligibility for Medicaid and other government-funded assistance programs. This role plays a critical part in ensuring that patients receive the financial support they need while helping the organization secure appropriate reimbursement.
Responsibilities
- Conduct comprehensive interviews with patients, family members, or guardians to gather necessary financial and demographic information.
- Review medical, financial, and legal documentation to assess and determine eligibility for Medicaid and other public assistance programs in Illinois.
- Submit and track Medicaid applications through Illinois Department of Human Services (IDHS) portals and systems, such as ABE (Application for Benefits Eligibility) and MEDI (Medical Electronic Data Interchange).
- Communicate regularly with state agencies, caseworkers, and third-party eligibility vendors to follow up on application status and resolve issues.
- Maintain up-to-date knowledge of Illinois Medicaid regulations, eligibility criteria, managed care plans, and redetermination processes.
- Educate patients and families on available benefits and the application process.
- Ensure accurate documentation and compliance with HIPAA and other privacy regulations.
- Collaborate with case management, billing, and social services teams to coordinate patient care and financial services.
- Participate in audits and reporting activities as needed.
Qualifications
- High school diploma or equivalent; Associate or Bachelor’s degree preferred.
- Minimum 2 years of experience working with Illinois Medicaid eligibility or similar public assistance programs.
- Familiarity with Illinois Medicaid systems (ABE, MEDI, MMIS, etc.) and managed care organizations (MCOs).
- Strong understanding of Medicaid guidelines, application, redetermination, and verification processes.
