Medicaid Eligibility Specialist
- Las Cruces, NM
The Outsource Group is a leading revenue cycle management company serving hospitals and physician practices. Our clients choose us because of the effectiveness of our revenue cycle solutions that address the challenges within revenue cycle management, our strong cultural commitment to patient satisfaction while meeting client needs, the depth of our expertise delivered through our specialty Centers of Excellence, and our results—accelerated through analytically driven work flows enabled through leading-edge technology
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.
Essential Job Functions:
- 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.
- All other duties as assigned
Disclaimer: The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of responsibilities, duties and skills required.
- Knowledge: 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.
- 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. College degree preferred or high school diploma (equivalent).
- Competencies: 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.
All your information will be kept confidential according to EEO guidelines.