Medicaid Eligibility Representative

White Rock Medical Center LLC•Dallas, TX

23h

About The Position

Screen patients for Medicaid and other government program eligibility at bedside, registration, or via telephone. Complete and submit Medicaid applications accurately and timely in accordance with state and federal guidelines. Obtain and verify required documentation including income, residency, citizenship, disability, and household information. Educate patients and families on Medicaid benefits, eligibility requirements, and application processes. Act as liaison between patients, hospital departments, and state Medicaid offices. Track application status, follow up on pending cases, and resolve denials or requests for additional information. Document all eligibility activities in the hospital’s electronic health record (EHR) and eligibility systems. Collaborate with Patient Access, Case Management, Social Services, and Billing departments to ensure continuity of coverage. Ensure compliance with HIPAA, CMS regulations, and hospital policies. Meet productivity and quality benchmarks related to application approvals and turnaround times. Assist with audits, reporting, and performance improvement initiatives related to Medicaid eligibility. Maintain up-to-date knowledge of Medicaid policy changes and eligibility criteria.

Requirements

Minimum of 2-3 years' experience in Medicaid eligibility, patient access, financial counseling, or healthcare registration
Knowledge of Medicaid eligibility rules and application processes
Proficiency with electronic eligibility systems and EHR platforms
Strong attention to detail and documentation accuracy
Excellent verbal and written communication skills
Ability to handle sensitive financial and personal information with discretion
Strong customer service and patient advocacy skills
Associate’s degree or higher in healthcare administration, social services, or related field
Hospital or acute care experience
Experience with state Medicaid portals and verification tools
Bilingual (English/Spanish) preferred
Familiarity with CMS, SSI, disability Medicaid, and emergency Medicaid programs
May include weekends, holidays, or extended hours based on patient census and hospital needs.

Nice To Haves

Hospital or acute care experience
Experience with state Medicaid portals and verification tools
Bilingual (English/Spanish) preferred
Familiarity with CMS, SSI, disability Medicaid, and emergency Medicaid programs

Responsibilities

Screen patients for Medicaid and other government program eligibility
Complete and submit Medicaid applications accurately and timely
Obtain and verify required documentation
Educate patients and families on Medicaid benefits, eligibility requirements, and application processes
Act as liaison between patients, hospital departments, and state Medicaid offices
Track application status, follow up on pending cases, and resolve denials or requests for additional information
Document all eligibility activities in the hospital’s electronic health record (EHR) and eligibility systems
Collaborate with Patient Access, Case Management, Social Services, and Billing departments to ensure continuity of coverage
Ensure compliance with HIPAA, CMS regulations, and hospital policies
Meet productivity and quality benchmarks related to application approvals and turnaround times
Assist with audits, reporting, and performance improvement initiatives related to Medicaid eligibility
Maintain up-to-date knowledge of Medicaid policy changes and eligibility criteria