Medicaid Eligibility Coordinator in Grand Island, Nebraska at Bryan Health

GENERAL SUMMARY:

Responsible for coordinating Medicaid enrollment processes across regional and critical access hospitals. Trains and supports staff on Medicaid enrollment operations and serves as a resource for complex eligibility issues. Performs quality oversight activities, including audits, to ensure consistency and compliance. Also responsible for identifying, screening, and enrolling eligible patients into Medicaid and related public assistance programs, working directly with patients, families, clinical teams, and government agencies to secure coverage, reduce uncompensated care, and support timely reimbursement. Ensures applications are completed accurately, submitted timely, and followed through to determination in compliance with all federal, state, and organizational requirements.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Coordinates Medicaid enrollment operations across regional and critical access hospitals, ensuring consistent processes, compliance, and performance standards are maintained.

3. *Trains staff on Medicaid eligibility processes and standards across regional facilities to ensure consistent application of policies, procedures, and regulatory requirements.

4. *Serves as a team resource for Medicaid eligibility staff, providing ongoing guidance, coaching, and support to promote accurate and compliant practices.

5. *Conducts regular audits and reviews of Medicaid eligibility work performed by staff in regional hospitals and critical access hospitals to ensure accuracy, quality, and compliance with federal, state, and organizational requirements.

6. *Screens uninsured and underinsured patients for Medicaid and related program eligibility based on state and federal guidelines.

7. *Conducts patient interviews to obtain complete and accurate demographic, financial, and household information.

8. *Completes, submits, and tracks Medicaid applications within established timelines.

9. *Follows applications through approval, denial, or appeal and responds to requests for additional information.

10. *Educates patients and families on Medicaid benefits, coverage periods, and renewal requirements.

11. Assists patients with presumptive eligibility when applicable and follows Bryan’s Presumptive eligibility process.

12. Collaborates with registration, case management, social work, and clinical staff to identify eligible patients.

13. Collaborates with Patient Financial Counselors in the financial assistance review for non-Medicaid eligible patients.

14. *Documents eligibility activities and application status in hospital systems.

15. *Ensures compliance with Medicaid regulations, hospital policies, and HIPAA.

16. Assists with coverage renewals and redeterminations.

17. Meets productivity and quality standards as established by leadership.

18. Participates in meetings, audits, committees, and department projects as assigned.

19. Maintains professional growth related to Medicaid policies and regulations.

20. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”).

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Maintains clinical competency as required for the unit including but not limited to age-specific competencies relative to patient’s growth and developmental needs, annual skill competency verification and mandatory education and competencies.

2. Knowledge of Medicaid eligibility and public assistance programs.

3. Knowledge of revenue cycle and patient accounting operations.

4. Ability to maintain confidentiality and comply with HIPAA requirements.

5. Knowledge of computer hardware equipment and software applications relevant to work functions.

6. Ability to communicate effectively both verbally and in writing.

7. Ability to perform crucial conversations with desired outcomes.

8. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

9. Ability to problem solve and engage independent critical thinking skills.

10. Ability to maintain confidentiality relevant to sensitive information.

11. Ability to prioritize work demands and work with minimal supervision.

12. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Associate’s degree in healthcare, social services, or business preferred.

Minimum two (2) years' experience in Medicaid eligibility or patient financial counseling. Acute care hospital or emergency department experience preferred. Must be 19 years of age to witness legal consents.

OTHER CREDENTIALS / CERTIFICATIONS:

Certification from a Healthcare accredited association such as HFMA, AHIMA, AAHAM, or AAPC preferred.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) – Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.