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medicaid eligibility specialist resume example with 9+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Proudly offering over 31 plus years' of dedicated service, experience at Community Hospice & Palliative Care/Alivia Care in various positions. Most recent current position Medicaid Eligibility Specialist.Polished professional known for interactions that are fair, compassionate and respectful. Promoting issue resolution expertise in fast-paced environments. Committed to engaging others delivering exceptional service. Ready to tackle new challenges. secura a position with a well established organization with a stable environment will lead to a lasting relationship Reliable professional, boasting expertise in managing eligibility information for Community Hospice staff/teams, patient/family representative.

Skills
  • Extensive knowledge of Medicaid Eligibility requirements
  • Microsoft Office, Microsoft Outlook and Word, Suncoast
  • Dedicated, Supportive, Team Player
  • Prioritize, Organize, Time Management,
  • Effectively communicate with team members, patient/family representatives from all backgrounds, area professionals and community partners, computers, oral, documenting.
Experience
05/2020 to Current Medicaid Eligibility Specialist Cbiz, Inc. | Delray Beach, FL,

* Review referrals/admits contact patient/family to conduct a phone interview within 24 hours of admission to complete Medicaid pre-screening and determine potential eligibility.

* Investigates, verifies accuracy of information provided by recipients, referring agencies under Medicaid programs to determine compliance with State and Federal laws, rules and regulations.

* Maintains effective public relations with medical facilities, federal, state, county and city agencies.

* Verifies accuracy of information listed on applicant's applications including but not limited to income, bank accounts, any/all financial accounts and other assets opened or closed within a 5 year look back period.

* Makes determination of applicant's eligibility based upon established criteria.

* HIPPA making sure patient/family personal/financial information is safeguarded at all times.

* Schedule in office or out of office appointments face to face if permissible with patient/representative to explain, review the Florida Medicaid income/asset requirements for the State of Florida. Complete application, collect all necessary releases, signatures, and documents within 5 business days of admission if possible.

* Work with patient/representative to collect all documents requested by DCF needed to determine eligibility to obtain Medicaid approval.

* Complete Medicaid application on-line using Access Florida website.

* Consistently served as liaison between collecting agencies, medical facilities, developing professional relationships through quick problem resolution and response to questions.

* Assist Hospice admission, home/ LTC team Social Workers in determining if a patient has Medicaid, type and if an application needs to be pursued.

* Assist patient/representative with applying for Social Security Benefits to allow for Medicaid approval.

* Attend DCF interviews at area locations or by phone.

* Attend training/in-services to increase skill/level knowledge.

* Assumes responsibility for Medicaid eligibility determination caseload for designated zip codes.

2014 to 2020 Psychosocial Coordinator Chimes | New Castle County, DE,

* Responsible for the supervision of and training Medicaid Generalists.

* Direct and prioritizes the case work functions of the Generalists in conjunction with the Psychosocial Coordinator and/or Psychosocial Program Manager.

* Meet with patient/family wherever located prior to admission/transfer to determine if patient meets Hospice Medicaid eligibility criteria.

* Coordinate with assigned DCF caseworker to schedule eligibility determination interviews at their DCF locations or by phone.

* Request and conduct DCF Appeal Hearings if case denied without cause.

* Work with patient/representative to collect all documents requested by DCF to obtain Medicaid approval within the DCF timeframes.

Record daily all communications/visits with patient, family, representative, financial institution, DCF, nursing home, ALF's Social Security, Social Service Agencies and community partners.

* Welcomed employees and guests, addressing needs with accurate information and support.

Develops and maintains relationships area professionals, hospitals, community partners.

*Attend workshops/trainings, educational certifications, seminars to increase skill level/knowledge.

2003 to 2005 Pre-Admissions Assistant Manager Community Hospice & Palliative Care | City, STATE,

Coordinate with intake facilitators to determine if visits is needed to determine Medicaid eligibility of potential admission to Community Hospice Care.

* Conduct interview with patient/representative to determine Medicaid eligibility and begin the application process.

* Responsible for the completion of all packets for Medicaid eligible patients, including necessary documentation, working in conjunction with finance department.

* Manage day-to-day operations of the psychosocial role in admissions process by assigning tasks and priorities for the pre-admissions specialist.

* Supervise the pre-admissions specialist, including but not limited to goals and objectives, performance evaluations, hourly employees time, providing direction and support as needed, making supervisory visits to the admissions specialist at least annually.

* Attend trainings/in-services to increase skill level/knowledge.

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Prior positions held during my 31 plus years of employment with Community Hospice of Northeast Florida, Community Hospice & Palliative Care, Alivia Care Inc.

* 11/90-1994 Social Worker 1

*1995-1996 Pre Admissions Specialist

* 1997-2000 Assessment Specialist

*2001-2003 Senior Assessment Specialist

*2006-2007 Pre Admissions Medicaid Specialist

* 2008-2014 Various positions Hospital Information Specialist, Community Hospice Liaison. Some was part time, became a caregiver.

Education and Training
Expected in 12/1984 to to Bachelor of Arts | Sociology Bethune - Cookman University, Daytona Beach, FL GPA:

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Resume Overview

School Attended

  • Bethune - Cookman University

Job Titles Held:

  • Medicaid Eligibility Specialist
  • Psychosocial Coordinator
  • Pre-Admissions Assistant Manager

Degrees

  • Bachelor of Arts

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