Medicaid Eligibility Analyst

Overview 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. Pursue your passion for caring with the Patient Revenue Management Organization, a 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 for Duke Health. MEDICAID ELIGIBILITY ANALYST Location and Schedule Hybrid remote position working 1-4 days a week remotely depending on departmental needs. Work hours Monday - Friday 8:00am - 5:00pm. Bilingual strongly preferred. Duties and Responsibilities 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. Conduct thorough interviews and evaluate patient’s case for potential eligibility for Medical Assistance Programs and applicable Purchase of Medical Care programs. Analyze patient’s assets, income, clinical history, and dependent responsibilities in accordance with federal regulations and Social Security Administration guidelines. Assess patient’s continuing care needs and determine correct program and certification period to maximize reimbursement and minimize patient deductible. Communicate and advise patients on complex financial concepts and procedures of applying for Medicaid. May act as authorized patient’s representative for initiation of benefits applications and conduct any and all activities associated with determination of eligibility, including administrative and/or judicial appeals. Coordinate and facilitate completion of the Medicaid application, gather and provide necessary verifications to establish eligibility through direct contact with patient, family, employer, financial institution, vital statistics, and other collateral sources. Follow up with patient and the Department of Social Services to ensure all pertinent information has been provided. Travel to patient residence may be required for follow-ups, obtaining additional records, and verifying or correcting information. Evaluate case files for sufficiency of evidence or documentation, initiate fact finding and research supporting or denying case merit. Develop hearing briefs and assemble documentary evidence for local agency, State, and Chief Hearing Officer hearings. Enter relevant information into the hospital system, monitor authorization dates and deductible amounts, reconcile account financial status monthly, and serve as an educational resource on Medicaid issues for patients, Social Workers, Physicians, Clinic, and Admissions personnel. Review and monitor revisions in policy/regulations to determine the effect on pending applications. Perform related duties incidental to the work described herein. Performance Standards Average screening turnaround to resolution within 14 days of receiving referral Follow-up on Medicaid applications at minimum every 15 days, resolve accounts on average within 90 days of submission Achieve 80% or greater Medicaid application approval percentage Achieve 90% or greater on monthly attorney review/auditing Required Qualifications 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. Ability to handle complex, high-volume, sometimes contradictory information, make timely decisions, learn when faced with new situations, adapt quickly and positively to change, perform multiple tasks independently and collaboratively with stakeholders such as patients, physicians, case managers, social workers, co-workers, supervisors, and representatives at Department of Social Services/Department of Disability Services. Demonstrated negotiation skill, empathy, teamwork, and compliance with Duke Health and Medicaid policies and procedures. Distinguishing Characteristics Position responsible for high production generated accurately in accordance with established business processes or regulation. Requires working knowledge of compliance principles. Job allows opportunity to work independently. 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. Equal Employment Opportunity Statement Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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. Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo. Contact Information Nearest Major Market: Durham. Nearest Secondary Market: Raleigh. #J-18808-Ljbffr