Medicaid Eligibility Specialist or an Eligibility Specialist will determine if the applicants meet the specified qualifications needed for various programs. A professional Medicaid Eligibility Specialist Resume indicates duties such as – interviewing the applicants and determining benefits or assistance eligibility, facilitating appointments and referrals, providing resources and materials to clients and reviewing submitted applications. The job description also indicates checking the facts for accuracy, record keeping, and rendering advocacy on behalf of the clients.
Job requirements vary based on the type of work undertaken, but employers typically require these skills and abilities from their potential employees – a high-level of communication skills, experience in counseling and advocacy, process tracking skills, ability to review applications accurately, computer proficiency and bilingual skills. Educational requirements vary based on the position, but most employers want to the minimum, an associate’s degree in the relevant field.
Headline : Self-starter with the ability to problem solve, increase productivity and decrease variances, along with strong training and education in implementing techniques.
Summary : Dedicated and focused Customer Service Rep who excels at prioritizing, completing multiple tasks simultaneously. Specialize in Administrative support to a busy security office.
Skills : Technical Skills, Critical Thinking.
Description :
Provided consultation and technical assistance to a nursing home, hospital, hospice, and rehabilitation services personnel and family members.
Served as a liaison with the community, state and federal agencies to coordinated client benefits and services.
Interviewed clients/their representatives to determine initial and Medicaid programs for the aged, blind, and disabled.
Scheduled appointments by written notices and telephone contacts.
Conducted in-depth personal interviews with clients and representatives.
Obtained pertinent information related to eligibility factors based on policies and procedures.
Identified clients' needs and made appropriate referrals to community resources and public services.
Experience
7-10 Years
Level
Management
Education
Business Management
Medicaid Eligibility Specialist III Resume
Summary : Eligibility specialists determine whether or not applicants for various programs meet the necessary qualifications.
Skills : Medical Terminology, Telemarketing, Customer Service.
Description :
Analyzed problems by evaluating available information and resources.
Calculated applicant eligibility by using basic mathematical operations.
Developed effective, viable solutions to problems that can help drive the effectiveness of the department.
Developed referral networking systems by initiating and maintaining contact with community partners.
Consistently delivered required business results; sets and achieves achievable, yet aggressive, goals.
Maintained focus on Agency and State goals.
Worked with team members to develop, organize, and implement organizational activities.
Demonstrates consistently the ability to interface with a wide range of personnel with tact.
Summary : Seeking a full time position in public health or related field. Usually they work with government aid, especially in the health care industry, like Medicare or Medicaid.
Worked involves interviewing clients, documenting information gathered.
Determined benefits, verifying case data, explaining program benefits and requirements.
Reviewed eligibility of clients for ongoing services.
Interviewed clients or authorized representative to gather information to determine eligibility for benefits.
Conducted reviews to determine or verify eligibility or continued eligibility and benefit level.
Processed changes to client status, overpayments, and adjusts or restores benefits.
Obtained, verified, and calculated income and resources to determine client financial eligibility.
Documented case records using automated equipment to form a record for each client.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Arts
Medicaid Eligibility Specialist I Resume
Objective : Friendly office assistant with extensive experience dealing with Medicaid, Medicare, Social Security, VA and Clark County. Skilled at communicating and developing professional relationships.
Skills : Business Applications, Record keeping, Keyboarding.
Description :
Assumed responsibility for approximately ongoing and pending Medicaid and County cases.
Met with the resident or their representative to review the resident's financial situation and determine which medical assistance program was appropriate.
Completed medical assistance application; acquired necessary documents, releases, and signatures.
Prepared written communications to advise the resident or their representative of further required documentation.
Submitted the medical assistance application and required documentation in a timely manner to the appropriate agency.
Contacted various program caseworkers. Determined eligibility for Medicaid.
Completed applications, budgets, and interviews.
Experience
2-5 Years
Level
Junior
Education
Diploma
Sr. Medicaid Eligibility Specialist Resume
Summary : To become an effective member of a goal oriented organization that will take advantage of organizational and leadership skills to meet agency objectives.
Compiled information necessary to complete referrals for the elderly waiver program.
Compiled information needed to determine eligibility for the elderly waiver funded through Medicaid.
Verified documentation of the financial need for payment of services.
Acted as a liaison between applicants and the Department of Human Services.
Provided initial applications and documentation to Medicaid eligibility workers.
Maintained dialogue with income maintenance workers from the Department of Human Services regarding eligibility for the program.
Maintained an extensive knowledge of Medicaid eligibility policies.
Maintained strong working relationships with personnel from area health agencies and the Department of Human Services.
Experience
10+ Years
Level
Senior
Education
Diploma
Medicaid Eligibility Specialist/Executive Resume
Summary : A challenging position as a Medicaid Eligibility Specialist which will allow to both further utilize skills and acquire new abilities.
Skills : Technical Skills, Organized.
Description :
Specialized the Medicaid unit was located within the University of VA hospital.
Received possible Medicaid eligible referrals from the UVA Admissions office based on the information given at the time of admission.
Interviewed patients or family members gather information such as income, resources, and/or other items to determine eligibility.
Contacted banks, employers, personal property, social security; all to determine patient eligibility.
Contacted with hospital social workers and admissions office.
Respected at all times, patient confidentiality.
Able to relate and correspond with patient and all necessary parties.
Experience
10+ Years
Level
Senior
Education
High School
Lead Medicaid Eligibility Specialist Resume
Summary : To obtain a position which enables to utilize business expertise and strong organizational skills. Medicaid Eligibility Specialist is responsible for developing and implementing the Medicaid eligibility process in the states.
Met with uninsured hospital patients to review their eligibility for Medicaid and other community-funded resources.
Analyzed and updated the hospital's electronic health records.
Provided input for increasing the hospital's Medicaid revenue Preparing daily reports to identify progress towards meeting financial goals.
Validated and reviewed services rendered by the hospital prior to submitting billing for payment.
Served as a liaison between Adreima and other organizations such as Social Services.
Submitted billing to the state or appropriate funding source for payment.
Updated management on the financial status of unresolved accounts.
Experience
10+ Years
Level
Senior
Education
Management
Medicaid Eligibility Specialist I Resume
Objective : Management experience in a DSS setting and performed follow-up and case maintenance as needed. Medicaid Eligibility Specialist also works closely with providers to ensure that eligibility is maintained and that the provider’s services are covered by the program.
Skills : Analytical Skills, Critical Thinking.
Description :
Worked with patients who are without private health insurance with application eligibility to various Federal, state, local and private programs.
Interviewed patients to screen for available services.
Maintained files to ensure deadlines are met and that the applications are processed in a timely manner.
Investigated information was given by patients for accuracy.
Processed hospital Charity Care applications and provide follow-up with patients for additional information, approvals, and denials.
Maintained patient confidentiality and follow all HIPPA laws.
Handled cash, check, and credit card payments for medical services.
Maintained accurate reporting to superiors.
Experience
2-5 Years
Level
Junior
Education
Bachelor's
Associate Medicaid Eligibility Specialist Resume
Summary : Experienced in Microsoft Office Suite, along with standard software and office equipment used in the workplace.
Skills : Technical Skills, Process Management.
Description :
Worked to help Georgia families obtain access to free and low-cost health insurance.
Communicated moderately complex information and interacts through electronic documentation tools.
Experienced in processing P4HB applications for Women's Medicaid, Newborn report, Operation Registration, Spin-Offs.
Processed standard Medicaid applications, and Short Circuit FFM.
Referred members to other collaborative programs for extra assistance.
Operated in Success, Compass, GRITS, The Work Number, Web One, Vida, and UCM.
Created PDF files, reports, MS Office. Served as team lead when the supervisor is absent.
Experience
10+ Years
Level
Senior
Education
Environmental Science
Medicaid Eligibility Specialist Resume
Summary : Medicaid Eligibility Specialist is responsible for helping State Medicaid agencies meet their eligibility requirements.
Skills : Analytical Skills, Management.
Description :
Managed over active cases with recipients. Responsible for the calculation of budgets.
Handled irate/difficult clients and providers to diffuse potentially volatile situations and to render services.
Communicated orally in a one-on-one situation to conduct client interviews.
Provided and gathered program information and explain results.
Organized information to ensure efficient office operation and case management.
Communicated orally in group situations to make presentations and conduct group interviews.
Operated a computer to include operation, maintenance, and troubleshooting to perform job duties.
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