KRMC Medicaid Eligibility Specialist in Kearney, Nebraska at Bryan Health

GENERAL SUMMARY:

The Medicaid Eligibility Specialist is responsible for identifying, screening, and enrolling eligible patients into Medicaid and related public assistance programs. This role works directly with patients, families, clinical teams, and government agencies to secure coverage for acute care services, reduce uncompensated care, and support timely reimbursement. The specialist ensures applications are completed accurately, submitted timely, and followed through to determination while maintaining compliance with all federal, state, and organizational requirements.

PRINCIPAL JOB FUNCTIONS:

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

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

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

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

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

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

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

8. Collaborates with Registration, Case Management, Social Work, and Clinical staff to identify eligible patients.

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

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

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

12. Assists with coverage renewals and determinations.

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

14. Participates in meetings, audits, and department projects as assigned.

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

16. Performs other related projects and duties as assigned.

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

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

1. Knowledge of Medicaid eligibility and public assistance programs.

2. Knowledge of revenue cycle and patient accounting operations.

3. Understanding of federal and state Medicaid regulations.

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

5. Strong verbal and written communication skills.

6. Ability to explain complex information with empathy and professionalism.

7. Strong organizational and time management skills.

8. Ability to work independently in a fast-paced acute care environment.

9. Ability to establish effective working relationships.

10. 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, patient financial services, or healthcare registration. 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.