Medicaid Eligibility Representative

Description

• Screen patients for Medicaid and other government program eligibility at bedside, registration, or via telephone.
• Complete and submit Medicaid applications accurately and timely in accordance with state and federal guidelines.
• Obtain and verify required documentation including income, residency, citizenship, disability, and household information.
• Educate patients and families on Medicaid benefits, eligibility requirements, and application processes.
• Act as liaison between patients, hospital departments, and state Medicaid offices.
• Track application status, follow up on pending cases, and resolve denials or requests for additional information.
• Document all eligibility activities in the hospital’s electronic health record (EHR) and eligibility systems.
• Collaborate with Patient Access, Case Management, Social Services, and Billing departments to ensure continuity of coverage.
• Ensure compliance with HIPAA, CMS regulations, and hospital policies.
• Meet productivity and quality benchmarks related to application approvals and turnaround times.
• Assist with audits, reporting, and performance improvement initiatives related to Medicaid eligibility.
• Maintain up-to-date knowledge of Medicaid policy changes and eligibility criteria.

• Minimum of 2-3 years' experience in Medicaid eligibility, patient access, financial counseling, or healthcare registration
• Knowledge of Medicaid eligibility rules and application processes
• Proficiency with electronic eligibility systems and EHR platforms
• Strong attention to detail and documentation accuracy
• Excellent verbal and written communication skills
• Ability to handle sensitive financial and personal information with discretion
• Strong customer service and patient advocacy skills
• Associate’s degree or higher in healthcare administration, social services, or related field
• Hospital or acute care experience
• Experience with state Medicaid portals and verification tools
• Bilingual (English/Spanish) preferred
• Familiarity with CMS, SSI, disability Medicaid, and emergency Medicaid programs

May include weekends, holidays, or extended hours based on patient census and hospital needs.