QA Specialist - Financial Counseling

Overview

Job Summary

Serves as an representative for uninsured patients to secure Medicaid for their continuing care services bill(s). Works with or on behalf of patients through the end-to-end process of applying for North Carolina or South Carolina Medicaid programs. 

Essential Functions

•  Manages a caseload of uninsured patients evaluated for potential Medicaid eligibility. For patients who may qualify for Medicaid, educates patients on     program eligibility, the application process and associated deadlines. Works with or on behalf of patients to file Medicaid applications before the deadline.
•  Works closely with Department of Social Services (DSS) caseworkers to ensure all required information is submitted within the processing timeframe.   Routinely follows up with DSS and other state agencies to confirm they have all the information/documentation necessary to make an eligibility determination.
• Maintains expert knowledge of North Carolina and South Carolina Medicaid policies and procedures. Applies this knowledge throughout the application process to ensure compliance and addresses policy related questions/concerns directly with DSS and/or other state agencies.
• Regularly follows up with patients to provide the status of Medicaid applications and secure outstanding information required by DSS or other state agency.
• Requires frequent phone contact and follow-up with patients regarding Medicaid application progress and status
   

Physical Requirements

 

Work requires long periods of sitting. Works in a fast paced environment, which requires good concentration and ability to make rapid decisions. Must be able to lift up to 5 lbs.

Education, Experience and Certifications

Bachelor's Degree or 4 years experience in Patient Financial Services, Medicaid Eligibility, Social Work or Auditing required. Must have knowledge of Medicaid programs, Patient Accounting and Registration processes. PC computer with knowledge of Microsoft Office required.