Hybrid Medicaid Eligibility Analyst

at Duke Careers

• Job title: Medicaid Eligibility Analyst
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Durham, United States

About the role

• Medicaid Eligibility Analyst coordinating Medicaid application processes at Duke Health. Involves patient interviews, asset assessments, and compliance with federal regulations.

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, in-depth interviews and evaluate patient’s case for potential eligibility for Medical Assistance Programs and any applicable Purchase of Medical Care programs.
• Analysis of patient’s assets, income, clinical history, and dependent responsibilities, must be conducted in a precise manner based on knowledge and interpretation of the 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.
• In some cases, may act as the authorized patient’s representative for the purpose of initiating an application for benefits and for conducting any and all activities associated with determination of eligibility of benefits, including the initiation and conduct of administrative and /or judicial appeals.
• There is legal liability involved for the Medicaid Eligibility Analyst, as they are responsible to the county/state for the accuracy of information and actions taken on behalf of the patient.
• Coordinate and facilitate the completion of the Medicaid application.
• Gather and provide necessary verifications to establish Medicaid eligibility via direct contact with patient and/or patient’s family, employer, financial institution, vital statistics and other collaterals to the County Department of Social Services Income Maintenance Caseworker in the county of patient residency.
• Follow-up with patient and the Department of Social Services to ensure all pertinent information has been provided relevant to the Medicaid application.
• Anticipate and troubleshoot logistic and compliance barriers.
• Evaluate case files to determine issues and sufficiency of evidence or documentation, analyzing Social Security Administration rules, Division of Medical Assistance guidelines and relevant regulations for applicability.
• Initiate fact finding, research in support or denial of case merit.
• Based on findings, evaluate if challenge is appropriate and facilitate the request for a hearing from the responsible local agency or State Office of Hearings and Appeals if warranted.
• Prepare hearing briefs, assemble documentary evidence and exhibits to represent the patient at local agency, State and Chief Hearing Officer hearings for the purpose of reversing a negative decision with or without the patient’s assistance.
• Interview, evaluate and prepare potential witnesses for substantive evidence in support of the decision reversal.
• Present patient case, examine and cross examine witness, and enter evidence into the case file at adjudication hearings to establish patient’s eligibility for Medicaid.
• Responsible for entering pertinent information into the hospital system and closely monitoring authorization dates and deductible amounts applied to patient accounts.
• Reconcile account financial status coding monthly to ensure accounts are represented accurately.
• 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 on a regular basis to determine the effect of these revisions on pending applications.
• Perform other related duties incidental to the work described herein.

Requirements

• Bachelor's degree in business, healthcare administration, accounting, finance or a related field is required.
• Four years of related experience is required.
• Bilingual strongly preferred
• Excellent communication skills, oral and written.
• Managing 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.
• Must be able to work collaboratively 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.
• Shares own ideas/viewpoint in a compelling manner and negotiates skillfully when working toward an agreed solution or common goal.
• Ability to engage with individuals in their feeling, capabilities, and perspectives in order to best meet and anticipate their needs.
• Collaborate with others to promote cooperation and commitment within a team to achieve goals and deliverables.
• Must be able to understand, interpret, and comply with Duke Health and Medicaid policies and procedures.

Benefits

• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements