KRMC Medicaid Eligibility Specialist

General Summary

The Medicaid Eligibility Specialist is responsible for identifying, screening, and enrolling eligible patients into Medicaid and related public assistance programs. This role works directly with patients, families, clinical teams, and government agencies to secure coverage for acute care services, reduce uncompensated care, and support timely reimbursement.

Principal Job Functions

• Commits to the KRMC mission, vision, values, and goals and consistently demonstrates our core values.
• Screens uninsured and underinsured patients for Medicaid related program eligibility based on state and federal guidelines.
• Conducts patient interviews to obtain complete and accurate demographic, financial, and household information.
• Completes, submits, and tracks Medicaid applications within established timelines.
• Follows applications through approval, denial, or appeal and responds to requests for additional information.
• Educates patients and families on Medicaid benefits, coverage periods, and renewal requirements.
• Affords assistance to patients with presumptive eligibility when applicable and follows Bryan’s Presumptive Eligibility process.
• Collaborates with Registration, Case Management, Social Work, and Clinical staff to identify eligible patients.
• Collaborates with Patient Financial Counselors in the financial assistance review process for non-Medicaid eligible patients.
• Documents eligibility activities and application status in hospital systems.
• Ensures compliance with Medicaid regulations, hospital policies, and HIPAA.
• Affords assistance with coverage renewals and determinations.
• Maintains productivity and quality standards as established by leadership.
• Participates in meetings, audits, and department projects as assigned.
• Maintains professional growth related to Medicaid policies and regulations.
• Performs other related projects and duties as assigned.

Required Knowledge, Skills, And Abilities

• Knowledge of Medicaid eligibility and public assistance programs.
• Knowledge of revenue cycle and patient accounting operations.
• Understanding of federal and state Medicaid regulations.
• Ability to maintain confidentiality and comply with HIPAA requirements.
• Strong verbal and written communication skills.
• Ability to explain complex information with empathy and professionalism.
• Strong organizational and time management skills.
• Ability to work independently in a fast-paced acute care environment.
• Ability to establish effective working relationships.
• Ability to maintain regular and punctual attendance.

Education And Experience

• High school diploma or equivalent required.
• Associate’s degree in healthcare, social services, or business preferred.
• Minimum two (2) years’ experience in Medicaid eligibility, patient financial services, or healthcare registration.
• Acute care hospital or emergency department experience preferred.
• Must be 19 years of age to witness legal consents.

Other Credentials / Certifications

• Certification from a Healthcare accredited association such as HFMA, AHIMA, AAHAM, or AAPC preferred.