Medicaid Eligibility Specialist in Santa Ana at Parallon

Date Posted: 9/27/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Santa Ana
  • Job Type:
  • Experience:
    At least 3 year(s)
  • Date Posted:
    9/27/2018

Job Description






GENERAL SUMMARY OF DUTIES – Responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments.  The Benefits Advisor serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management.

DUTIES INCLUDE BUT ARE NOT LIMITED TO:
•        Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
•        Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment.
•        Ensures appropriate signatures are obtained on all necessary forms.
•        Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
•        Complete and file applications.
•        Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
•        Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately.
•        Document progress notes to the patient’s file and the hospital computer system.
•        Participates in ongoing, comprehensive training programs as required.
•        Follows policies and procedures to contribute to the efficiency of the office.
•        Covers and assists with other office functions as requested.
•        Will be required to make field visits as necessary.
•        Adheres to and supports organizational IT&S standards, policies, and procedures.
•        Adheres to Code of Conduct.
•        Performs other duties as assigned.

Job Requirements



KNOWLEDGE, SKILLS & ABILITIES

•       Working knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines.
•       An understanding of patient confidentiality to protect the patient and the clinic/corporation.
•       Demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly.
•       Ability to collect, synthesize and research complex or diverse information.
•       Exceptional customer service and the ability to plan organize and exercise sound judgment. 


EDUCATION
 Associates degree or Bachelor’s degree from an accredited college preferred. Two years prior experience in health care industry considered. 


EXPERIENCE
•        A minimum three years of hospital/medical business office experience with insurance procedures and patient interaction.
Strong familiarity with a variety of the field’s concepts, practices and procedures

PHYSICAL DEMANDS/WORKING CONDITIONS – Requires prolonged sitting, some bending,
stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally.  Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. Occasional travel to division data center and/or other facilities may be required.