Medicaid Eligibility Representative I (Finance)
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The Medicaid Eligibility Rep is responsible for interviewing patients or their representative for the purpose of determining a patients' financial eligibility for a variety of medical assistance programs to include ohio medicaid and financial assistance programs.
Responsible for collecting estimated patient liability such as deductibles and co-payments at preadmission and/or point of service.Minimum Required: High School Education or GED. Preferred: Associate degree. | Minimum Required: 1-2 years of office experience. Preferred: 2 years interviewing the public in connection with applications for financial assistance or relevant experience in the healthcare revenue cycle and/or epic Revenue Cycle applications.Financial Assessment:
• Interviews patients or their representative in person or by telephone using Benefit Screening to obtain financial and other eligibility data and assists patients in completing applications. Verifies accuracy of demographic and financial data and updates systems as needed. Obtains signatures for various Federal, State, and/or Local assistance programs. Assists the patient, when necessary, in completion of the application(s) to include doing the required reading, writing, and/or explanation of the document(s) and/or required verifications.
• Analyzes financial and eligibility data and reviews length of disability to determine potential eligibility for Federal, State and County programs; completes the necessary documents within the time limits specified by the appropriate government agency.
• Determines the patient's ability to reimburse the hospital; interviews and corresponds with patients, responsible relatives, attorneys, employers, agencies, and insurance companies to obtain, verify or clarify information.
• Reviews prior account notes and uses established methods to obtain information that might aid in the application process or establish there is existing third-party coverage.
• Updates system(s) as required with demographic information, account/guarantor notes, third party updates, etc...
• Determines and manages proper course of action for optimal reimbursement of healthcare charges (i.e., Spend Down eligibility, Cobra coverage, etc.)
• Decides on appropriateness and refer specific accounts to the Financial Counselor, Eligibility Vendors, County Department of Job and Family Services, etc.
Program Eligibility:
• Analyzes financial applications along with income/resident documentation in order to determine the best way to assist the patient.
• Refers qualifying accounts to the Financial Counselor for possible linkage to Medicaid or federal disability programs.
• Obtains and distributes (with proper authorization) medical records for Medical Eligibility determinations and litigation.
• Researches and provides patients with information in order for them to make decisions regarding their insurance coverage and provider of care.
• Documents all follow-up activity in the hospital financial system.
• Monitors the pending accounts by using the Financial Counseling ONTRAC® worklist to assure that follow-up takes place as required.
• Communicates difficult or unusual account matters to the Supervisor for assistance.
Reimbursement/Collection:
• Follow-up for collection of payments for deposits, settlements, payment arrangements, out-of-network settlements, specialty services (i.e., cosmetic, obstetrics, oral surgery, etc.)
• Maintains current knowledge of collection and fair debt practices.
Miscellaneous:
• Attends seminars and courses on relevant topics (i.e., Medicare, Medicaid, Government HMO's, Hamilton County Tax Levy Regulations, and OHCAP regulation). Educating affected areas to apply information accordingly for compliance of program regulations.
• Obtains interpreters, (either verbal or sign language) for patients. for non-English speaking or deaf patients.
• Interacts cooperatively with Patient Relations and Risk Management to resolve patient issues.
• Maintains effective communication and cooperative working relationships with other department, staff, and members of medical staff, patients, and visitors.
• Performs other related duties as assigned.Financial Assessment:
• Interviews patients or their representative in person or by telephone using Benefit Screening to obtain financial and other eligibility data and assists patients in completing applications. Verifies accuracy of demographic and financial data and updates systems as needed. Obtains signatures for various Federal, State, and/or Local assistance programs. Assists the patient, when necessary, in completion of the application(s) to include doing the required reading, writing, and/or explanation of the document(s) and/or required verifications.
• Analyzes financial and eligibility data and reviews length of disability to determine potential eligibility for Federal, State and County programs; completes the necessary documents within the time limits specified by the appropriate government agency.
• Determines the patient's ability to reimburse the hospital; interviews and corresponds with patients, responsible relatives, attorneys, employers, agencies, and insurance companies to obtain, verify or clarify information.
• Reviews prior account notes and uses established methods to obtain information that might aid in the application process or establish there is existing third-party coverage.
• Updates system(s) as required with demographic information, account/guarantor notes, third party updates, etc...
• Determines and manages proper course of action for optimal reimbursement of healthcare charges (i.e., Spend Down eligibility, Cobra coverage, etc.)
• Decides on appropriateness and refer specific accounts to the Financial Counselor, Eligibility Vendors, County Department of Job and Family Services, etc.
Program Eligibility:
• Analyzes financial applications along with income/resident documentation in order to determine the best way to assist the patient.
• Refers qualifying accounts to the Financial Counselor for possible linkage to Medicaid or federal disability programs.
• Obtains and distributes (with proper authorization) medical records for Medical Eligibility determinations and litigation.
• Researches and provides patients with information in order for them to make decisions regarding their insurance coverage and provider of care.
• Documents all follow-up activity in the hospital financial system.
• Monitors the pending accounts by using the Financial Counseling ONTRAC® worklist to assure that follow-up takes place as required.
• Communicates difficult or unusual account matters to the Supervisor for assistance.
Reimbursement/Collection:
• Follow-up for collection of payments for deposits, settlements, payment arrangements, out-of-network settlements, specialty services (i.e., cosmetic, obstetrics, oral surgery, etc.)
• Maintains current knowledge of collection and fair debt practices.
Miscellaneous:
• Attends seminars and courses on relevant topics (i.e., Medicare, Medicaid, Government HMO's, Hamilton County Tax Levy Regulations, and OHCAP regulation). Educating affected areas to apply information accordingly for compliance of program regulations.
• Obtains interpreters, (either verbal or sign language) for patients. for non-English speaking or deaf patients.
• Interacts cooperatively with Patient Relations and Risk Management to resolve patient issues.
• Maintains effective communication and cooperative working relationships with other department, staff, and members of medical staff, patients, and visitors.
• Performs other related duties as assigned.
