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Medicaid Eligibility Specialist
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Full-time
- Summary: The Medicaid Eligibility Specialist screens, coordinates and facilitates the Medicaid application process across multidisciplinary entities for patients who meet the eligibility criteria.
- In some cases, may act as the authorized patient’s representative for the purpose of initiating an application for benefits as well as conducting any and all activities associated with determination of eligibility of benefits; including the initiation and conduct of administrative and/or judicial, local and up to State appeals.
- Gathers and provides necessary verification to establish Medicaid eligibility via direct contact with patient and/or patient’s family, employer, financial institution, vital statistics and other collaterals to local Counties Department of Social Services Income Maintenance Caseworker in the county where the patient has residency.
- Follows up with patient and the Department of Social Services to ensure all pertinent information has been provided relevant to the Medicaid application including disability determination, children and families and Emergency Medicaid
- Based on findings, evaluates and Represents the patient(s) if challenges presents including Denials and Unsatisfied approvals/decisions from the local Counties Department of Social Services and facilitates the request for a hearing from the responsible local agencies, State and Chief Hearing Officer for the purpose of reversing a negative decision with or without the patient’s assistance/presence.
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