SUMMARY: Assist assigned clients in identifying and representing self-pay patients that are potentially eligible for medical coverage through a federal or state agency that provides medical reimbursement for incurred medical services.
- Accept assigned client(s) referrals.
- Contact and interview patients and/or families to screen the appropriateness of filing applications(s) for medical coverage.
- File a timely, accurate and complete application(s) for eligibility medical coverage program to ensure program covers all available dates of service.
- Assist patients with obtaining the needed verifications and documentation (with patient’s authorizations) that is required to determine eligibility.
- Monitor and assist with the application process including attending interview when necessary to maintain all processing deadlines.
- Document and update status within Client and ClaimAid’s system on regular basis to maintain accountability.
- Report eligibility determinations to appropriate persons to secure revenue for clients and ClaimAid.
- Mentor peers including training as needed.
- Provide in-service training for current and prospective clients as assigned.
- Assist patient w/Appeals when appropriate.
- Keep current with trends and developments related to essential job competencies.
- Maintain confidentiality of patient health information in compliance with HIPAA regulations.
- Perform other job-related duties or special projects as required.
- Extensive knowledge of eligibility policy rules and processing requirements for programs administered by FSSA.
- Must have experience in experience with referrals and appeals with Medicaid/Social Security Disability Insurance
- High school diploma required; bachelor’s degree or equivalent business experience helpful.
- Strong investigative, analysis and judgment skills.
- Must have excellent spelling and grammar; good phone skills; basic math skills; organized; sets priorities; meets deadlines; able to multi-task; carefully proofs own work.
- Must demonstrate effective communication skills by conveying necessary information accurately, listening effectively and asking questions when clarification is needed.
- Ability to work independently and as part of a team.
- Professional demeanor both on the phone and in person.
- Ability to travel regionally with occasional overnight stay.
- Ability to shift back and forth between two or more tasks.
- Familiarity with Microsoft Office Tools.
- Being sensitive to the medical needs of the patient and professional duties of hospital staff.
- Is expected to represent the organization professionally at all times.
- Will be expected to meet all productivity requirements.
- Candidates must have valid driver’s license, liability insurance for the operation of a motor vehicle as well as reliable transportation
- Hearing: Adequate to perform job duties in person and over the telephone.
- Speaking: Must be able to communicate clearly to patients in person and over the telephone.
- Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
- Requires frequent bending, standing, walking (sometimes at a fast pace and at long periods of time), squatting and sitting.
The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.