Medicaid Investigator

About the role

Assists patient or family in completing Medicaid application. Assesses patient’s eligibility for Medicaid. Verifies patient’s information to complete application. Coordinates with various agencies and individuals to resolve individual cases.

Responsibilities

• Provides information regarding Medical Center regulations and policies pertaining to medical coverage.
• Contacts patient or family and conducts interviews to assess Medicaid eligibility.
• Meets with and assists patient or family in completing Medicaid applications to ensure coverage for Hospital, Nursing Facility, Home Care services and community Medicaid.
• Checks patient account for previous balances and advises patient of all financial obligations.
• Informs patient of Medical Center’s collection policy.
• Contacts physicians, nurses, social workers, employers, banks, etc. to obtain appropriate medical, legal and financial information to complete Medicaid application.
• Notifies appropriate hospital staff regarding Medicaid eligibility status and determination.
• Coordinates with various city and county agencies to resolve individual cases.
• Answers the telephone and maintains files.
• Informs Supervisor of activities, issues and problem cases.
• Accumulates data for performance reports.
• Maintains departmental files and statistical logs.
• Enters data into Medical Center’s patient registration system, financial management system, as well as Medical Eligibility Program database.
• Assists in scheduling patients for clinical visits, pre-admission testing, special tests and consultations via Medicaid screening process.

Qualifications

• High School Diploma or equivalent, required.
• Minimum of two (2) years experience in financial planning and assessment with regard to Medicaid and third party reimbursement sources.
• Ability to evaluate, research and document financial histories of patients in relation to Medicaid regulations.
• Good writing, organizational, interviewing and advocacy skills are essential.
• Demonstrated ability to operate data entry equipment, required.
• Ability to work well under pressure with heavy customer service and telephone contact.

Additional Salary Detail: The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).