Medicaid Eligibility Specialist II (Las Vegas, NV / Hybrid)

FreedomCare • Las Vegas, NV

17d • $20 - $23 • Hybrid

About The Position

The Medicaid Eligibility Specialist I focuses on enhancing the patient experience by verifying eligibility for Medicaid benefits, facilitating the approval process, and maintaining eligibility status to allow them to receive our services; expediting the time it takes for them to enroll into our programs. In addition to verifying patient eligibility and facilitating the approval process for Medicaid benefits, they will be responsible for ensuring compliance with all relevant regulations. The Medicaid Eligibility Specialist I requires a high level of attention to detail, excellent communication skills, and requires in-depth knowledge and understanding of Medicaid policies, regulations, and procedures.

Requirements

• Minimum of 2 years of experience in healthcare, insurance verification, or a related field.
• Experience with Medicaid verification and understanding of Medicaid regulations is highly preferred.
• Bilingual Spanish/English required
• Proven track record of strong customer focus and adaptability in a high call volume environment (inbound and outbound)
• A passion for providing a high level of customer service, including the ability to show empathy, active listening and patience.
• Effective written and verbal communication skills with the ability to engage with diverse audiences
• Ability to multitask, set priorities, and manage time effectively
• Technical proficiency with the ability to navigate through multiple systems; while maintaining attention to detail and data accuracy.
• Demonstrates fluency over all tools and resources specific to the role, with heavy reliance on Excel
• Ability to embrace change and departmental growth in an evergreen environment.

Nice To Haves

• Associate degree or higher in healthcare administration, business, or a related field preferred.

Responsibilities

• Develop in-depth understanding of Nevada Medicaid’s programs including benefits, eligibility requirements, and enrollment process through the development of contacts with the State Medicaid agency, identifying online resources, and attendance at relevant Medicaid meetings.
• Serve as the Subject Matter Expert (SME) for all questions related to Medicaid eligibility.
• Verify patient eligibility for Medicaid benefits using various online systems and tools.
• Assist patient with preliminary review of documentation and requirements for application for Medicaid, ensuring all required documentation is complete and accurate.
• Confirm coverage details and determine patient benefits and process based on Medicaid guidelines.
• Investigate Medicaid issues related to eligibility, deferrals, denials and re-certifications through contact with the Patient or Patient representative to identify the cause of eligibility related issues and offering recommendations for resolution.
• Maintain accurate and detailed records of verification processes and outcomes.
• Update patient records in Salesforce to reflect current Medicaid status.
• Serve as a point of contact for Medicaid inquiries from clients, caregivers, and Health plan partners.
• Assist clients in understanding Medicaid eligibility, benefits, and application processes.
• Advocate for clients to ensure they receive appropriate Medicaid services.
• Respond to inquiries from patients and healthcare providers regarding Medicaid coverage and eligibility.
• Work closely with partnering departments to resolve any issues related to Medicaid coverage and recertification.
• Assist with training staff members on Medicaid verification procedures and policies.
• Collaborate with partnering departments, case managers, and other healthcare professionals to support patients’ access to Medicaid benefits.

Benefits

• Medical, dental, and vision insurance
• Life insurance
• Short-term and long-term disability insurance
• 401(k) with company match
• Continuing education and professional development opportunities
• Opportunities for career growth
• Wellness programs
• Gym reimbursement
• Internet reimbursement
• Competitive compensation
• Technology and tools designed to support communication, documentation, and care coordination

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree