Duke University
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke Health's Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
MEDICAID ELIGIBILITY ANALYST Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Medicaid Eligibility Analyst who will embrace our mission of Advancing Health Together.
This is a
hybrid remote position
working between 1-4 days a week remotely depending on the needs of the department.
Work Hours Monday - Friday 8:00am - 5:00pm
Bilingual Strongly Preferred Bilingual strongly preferred.
General Description of the Job Class Coordinate and facilitate the Medicaid application process across multidisciplinary entities to obtain Medicaid eligibility for patients entitled to Medicaid for the purpose of attaining reimbursement for services provided by Duke University Health System.
Duties and Responsibilities
Conduct thorough, in-depth interviews and evaluate patient’s case for potential eligibility for Medical Assistance Programs and any applicable Purchase of Medical Care programs.
Analyze patient’s assets, income, clinical history, and dependent responsibilities in a precise manner based on knowledge and interpretation of federal regulations and Social Security Administration guidelines; assess patient’s continuing care needs and determine correct program and certification period to minimize patient deductible and maximize entity reimbursement.
Communicate and advise patients on complex financial concepts and procedures of applying for Medicaid; act as the authorized patient’s representative for initiating applications and conducting administrative and/or judicial appeals, bearing legal liability for accuracy.
Coordinate and facilitate completion of the Medicaid application; gather and provide necessary verifications to establish eligibility via direct contact with patient and/or family, employer, financial institution, vital statistics, and other collaterals to the County Department of Social Services Income Maintenance Caseworker in the patient’s county of residency.
Follow-up with patient and the Department of Social Services to ensure all pertinent information has been provided; may require travel to the county for transport, obtaining additional records, and verifying information on behalf of the patient.
Evaluate case files to determine issues and sufficiency of evidence; initiate research for denial or challenge; facilitate hearings when warranted.
Prepare hearing briefs, assemble documentary evidence and exhibits to represent the patient at local agency, state, and chief hearing officer hearings; interview and prepare potential witnesses; present patient case and enter evidence.
Enter pertinent information into the hospital system and monitor authorization dates and deductible amounts applied to patient accounts.
Reconcile account financial status coding monthly to ensure accurate account representation.
Serve as an educational resource on Medicaid issues for patients, social workers, physicians, clinic and admissions personnel.
Review and monitor revisions in policy/regulations for all Medicaid programs to determine effects on pending applications.
Perform other related duties incidental to the work described hereby.
Performance Standards
Average screening turnaround to resolution within 14 days of receiving referral.
Follow-up on Medicaid applications at a minimum of every 15 days, resolving accounts on average within 90 days of application submission.
Achieve 80% or greater Medicaid application approval percentage.
Achieve 90% or greater on monthly attorney review/auditing.
Required Qualifications at this Level Education Bachelor's degree in business, healthcare administration, accounting, finance, or a related field is required.
Experience Four years of related experience is required.
Knowledge, Skills, and Abilities Bilingual strongly preferred.
Excellent communication skills, oral and written.
Manage sense of complex, high quantity, and sometimes contradictory information to effectively solve problems, while making good and timely decisions that keep the organization moving forward.
Ability to actively learn when facing new situations, adapt quickly and positively to change, perform multiple tasks, and work independently.
Collaborate with others to meet shared objectives while maintaining professional, service-oriented working relationships with key stakeholders such as patients, physicians, case managers/social workers, co-workers, supervisors, and representatives at Department of Social Services/Department of Disability Services.
Share own ideas/viewpoint in a compelling manner and negotiate skillfully when working toward an agreed solution or common goal.
Engage with individuals in their feelings, capabilities, and perspectives to best meet and anticipate their needs.
Collaborate to promote cooperation and commitment within a team to achieve goals and deliverables.
Understand, interpret, and comply with Duke Health and Medicaid policies and procedures.
Distinguishing Characteristics of this Level Position responsible for high production generated accurately in accordance with established business processes or regulation. Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an affirmative action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
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About Duke Health's Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
MEDICAID ELIGIBILITY ANALYST Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Medicaid Eligibility Analyst who will embrace our mission of Advancing Health Together.
This is a
hybrid remote position
working between 1-4 days a week remotely depending on the needs of the department.
Work Hours Monday - Friday 8:00am - 5:00pm
Bilingual Strongly Preferred Bilingual strongly preferred.
General Description of the Job Class Coordinate and facilitate the Medicaid application process across multidisciplinary entities to obtain Medicaid eligibility for patients entitled to Medicaid for the purpose of attaining reimbursement for services provided by Duke University Health System.
Duties and Responsibilities
Conduct thorough, in-depth interviews and evaluate patient’s case for potential eligibility for Medical Assistance Programs and any applicable Purchase of Medical Care programs.
Analyze patient’s assets, income, clinical history, and dependent responsibilities in a precise manner based on knowledge and interpretation of federal regulations and Social Security Administration guidelines; assess patient’s continuing care needs and determine correct program and certification period to minimize patient deductible and maximize entity reimbursement.
Communicate and advise patients on complex financial concepts and procedures of applying for Medicaid; act as the authorized patient’s representative for initiating applications and conducting administrative and/or judicial appeals, bearing legal liability for accuracy.
Coordinate and facilitate completion of the Medicaid application; gather and provide necessary verifications to establish eligibility via direct contact with patient and/or family, employer, financial institution, vital statistics, and other collaterals to the County Department of Social Services Income Maintenance Caseworker in the patient’s county of residency.
Follow-up with patient and the Department of Social Services to ensure all pertinent information has been provided; may require travel to the county for transport, obtaining additional records, and verifying information on behalf of the patient.
Evaluate case files to determine issues and sufficiency of evidence; initiate research for denial or challenge; facilitate hearings when warranted.
Prepare hearing briefs, assemble documentary evidence and exhibits to represent the patient at local agency, state, and chief hearing officer hearings; interview and prepare potential witnesses; present patient case and enter evidence.
Enter pertinent information into the hospital system and monitor authorization dates and deductible amounts applied to patient accounts.
Reconcile account financial status coding monthly to ensure accurate account representation.
Serve as an educational resource on Medicaid issues for patients, social workers, physicians, clinic and admissions personnel.
Review and monitor revisions in policy/regulations for all Medicaid programs to determine effects on pending applications.
Perform other related duties incidental to the work described hereby.
Performance Standards
Average screening turnaround to resolution within 14 days of receiving referral.
Follow-up on Medicaid applications at a minimum of every 15 days, resolving accounts on average within 90 days of application submission.
Achieve 80% or greater Medicaid application approval percentage.
Achieve 90% or greater on monthly attorney review/auditing.
Required Qualifications at this Level Education Bachelor's degree in business, healthcare administration, accounting, finance, or a related field is required.
Experience Four years of related experience is required.
Knowledge, Skills, and Abilities Bilingual strongly preferred.
Excellent communication skills, oral and written.
Manage sense of complex, high quantity, and sometimes contradictory information to effectively solve problems, while making good and timely decisions that keep the organization moving forward.
Ability to actively learn when facing new situations, adapt quickly and positively to change, perform multiple tasks, and work independently.
Collaborate with others to meet shared objectives while maintaining professional, service-oriented working relationships with key stakeholders such as patients, physicians, case managers/social workers, co-workers, supervisors, and representatives at Department of Social Services/Department of Disability Services.
Share own ideas/viewpoint in a compelling manner and negotiate skillfully when working toward an agreed solution or common goal.
Engage with individuals in their feelings, capabilities, and perspectives to best meet and anticipate their needs.
Collaborate to promote cooperation and commitment within a team to achieve goals and deliverables.
Understand, interpret, and comply with Duke Health and Medicaid policies and procedures.
Distinguishing Characteristics of this Level Position responsible for high production generated accurately in accordance with established business processes or regulation. Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an affirmative action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
#J-18808-Ljbffr