The basic job description for this position is to determine if the applicant is qualified for various programs typically in a medical setting. The major tasks that can be seen on the Medicaid Specialist Resume include – interviewing clients and their documents; gathering data and verifying case data; providing information and referral service to clients, preparing response letters, explaining program benefits and requirements to clients, maintaining files of appeals and grievances, investigating Medicaid issues, maintaining compliant and compliant-appeal logs, and explaining about benefits to the clients.
The following core competencies are normally expected on the resumes – well-versed in handling intakes by adhering with established eligibility criteria, interviewing skills, knowledge of resources generation and performance appraisals, and deductive reasoning skills. Depending on the responsibilities, candidates may or may not need a bachelor’s degree. But, possessing a high school diploma is mandatory.
Objective : Dedicated Medicaid Specialist with two years of experience in eligibility determination and case management. Proven ability to assess applicant information and ensure compliance with Medicaid regulations. Adept at collaborating with healthcare providers and government agencies to facilitate access to services. Committed to improving patient outcomes through effective communication and support.
Conduct thorough Medicaid eligibility assessments for applicants in assigned territory.
Verify and validate applicant information, including income and asset documentation.
Ensure compliance with Medicaid eligibility criteria and regulations.
Foster positive relationships with healthcare providers and government agencies.
Assist in training new Medicaid Specialists and clerical staff.
Evaluate and enhance eligibility program processes for efficiency.
Manage a caseload of active applications, ensuring timely processing and follow-up.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in H.A.
Lead Medicaid Specialist Resume
Headline : Accomplished Medicaid Specialist with over 7 years of comprehensive experience in eligibility determination and case management. Expertise in navigating complex Medicaid regulations and collaborating with healthcare providers to enhance service access. Passionate about optimizing patient outcomes through effective advocacy and meticulous attention to detail.
Skills : Data Analysis Using Excel, Presentation Development, Document Transmission, Multi-line Communication, Medicaid Claims Processing
Description :
Educates patients on Medicaid eligibility requirements and assists in financial planning to qualify for benefits.
Identifies and processes recertification files, ensuring timely completion of required assessments for Medicaid eligibility.
Tracks and manages the status of Medicaid applications, ensuring all documentation is complete and accurate.
Communicates with applicants to gather necessary information within strict deadlines.
Reviews and resolves claims denials, advising applicants on appeal processes and timelines.
Collaborates with healthcare providers to ensure compliance with Medicaid regulations and improve patient access to services.
Monitors changes in Medicaid policies and regulations, updating internal procedures as necessary.
Experience
5-7 Years
Level
Senior
Education
B.S. in Health Admin.
Medicaid Specialist Resume
Objective : Proficient Medicaid Specialist with two years of hands-on experience in eligibility assessment and case management. Skilled in interpreting Medicaid regulations and collaborating with healthcare entities to streamline service access. Focused on enhancing client experiences through strong communication and support, aiming to positively impact patient care outcomes.
Skills : Medicaid Compliance Regulations, Data Analysis, Eligibility Assessment, Regulatory Compliance, Client Advocacy Skills, Cultural Competency
Description :
Manage a Medicaid eligibility determination caseload, ensuring compliance with state and federal guidelines.
Evaluate applicant information for accuracy and completeness, determining eligibility for institutional care.
Conduct outreach visits to medical facilities and contact centers to support regional offices.
Maintain detailed records of case assessments and eligibility determinations.
Assist clients in understanding Medicaid benefits and application processes.
Collaborate with healthcare providers to ensure clients receive necessary services.
Participate in training sessions to enhance knowledge of Medicaid policies and regulations.
Experience
0-2 Years
Level
Junior
Education
B.S. in HA
Senior Medicaid Specialist Resume
Summary : Seasoned Medicaid Specialist with a decade of experience in eligibility determination and case management. Expertise in interpreting Medicaid policies and ensuring compliance with federal and state regulations. Proven track record of collaborating with healthcare providers to enhance service delivery and improve patient outcomes through strategic advocacy and communication.
Skills : Team Collaboration, Healthcare Compliance, Billing Procedures, Record Keeping, Policy Interpretation, Interpersonal Skills
Description :
Evaluate Medicaid eligibility for a diverse caseload, ensuring adherence to state and federal guidelines.
Verify client information accuracy to maintain compliance with Medicaid regulations.
Conduct regular outreach to hospitals and agencies for patient verification and support.
Maintain detailed records of client interactions and eligibility determinations.
Provide guidance and support to clients regarding Medicaid services and benefits.
Collaborate with regional offices to address complex eligibility cases.
Travel to community locations to assist clients in navigating Medicaid processes.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Medicaid Specialist Resume
Objective : With five years of extensive experience as a Medicaid Specialist, I excel in eligibility determination and case management. My expertise lies in ensuring compliance with Medicaid regulations while collaborating effectively with healthcare providers and government agencies. I am dedicated to enhancing patient access to vital services and improving health outcomes through strategic advocacy and comprehensive support.
Assisted clients in understanding Medicaid eligibility requirements and application processes.
Verify and assess applicant information, including income and assets, to determine eligibility accurately.
Maintain effective communication with medical facilities and government agencies to facilitate access to services.
Assist in training new Medicaid Specialists and clerical personnel, enhancing team capabilities.
Evaluate ongoing eligibility for Medicaid applicants and recipients, conducting regular reviews.
Maintain a caseload of active cases, ensuring timely responses and updates to applicants.
Implement strategies to improve public relations and patient outreach initiatives.
Experience
2-5 Years
Level
Management
Education
B.S. in Health Admin.
Medicaid Claims Specialist Resume
Objective : Results-oriented Medicaid Claims Specialist with two years of experience in eligibility assessment and claims processing. Demonstrated expertise in ensuring regulatory compliance and optimizing claims management. Skilled in collaborating with healthcare providers to streamline service access and enhance patient care outcomes through effective communication.
Skills : Collaboration, Attention To Detail, Problem-solving Abilities, Communication Skills
Description :
Managed Medicaid claims processing for a state-funded agency, ensuring compliance with regulatory standards.
Reviewed medical documentation and performed intake assessments to determine eligibility for benefits.
Analyzed state and federal resource data to verify applicant eligibility and compliance.
Led training initiatives for staff on Medicaid guidelines and claims management processes.
Acted as a consultant for a pilot Medicaid buy-in program, providing expertise and support.
Coordinated with clients to address inquiries and resolve issues related to claims and benefits.
Maintained accurate records of Medicaid accounts receivable and managed claim denials effectively.
Experience
0-2 Years
Level
Entry Level
Education
A.S. in HIM
Medicaid Specialist Resume
Objective : Detail-oriented Medicaid Specialist with over 5 years of experience in eligibility determination, claims processing, and compliance. Proven track record in managing complex cases and ensuring adherence to state and federal regulations. Strong analytical skills and a commitment to providing exceptional service to clients and stakeholders.
Skills : Microsoft Office Suite, Training And Mentoring, Conflict Resolution, Medicaid Enrollment Processes, Quality Assurance Skills, Report Generation
Description :
Developed training materials and handouts for staff and provider training sessions, enhancing understanding of Medicaid processes.
Engaged with governmental agencies, public officials, and private organizations to execute project assignments effectively.
Assisted in preparing legislative and statistical reports for budgeting, ensuring accuracy and compliance.
Performed subsystem edits and managed provider correspondence to maintain clear communication.
Communicated policies and procedures regarding federal and state regulations to relevant stakeholders.
Conducted onsite assessments for potential and current provider facilities to ensure compliance with Medicaid standards.
Consulted with program directors and administrators on project objectives, data collection, and analysis to meet deadlines.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Associate Medicaid Specialist Resume
Objective : Compassionate Associate Medicaid Specialist with two years of experience in eligibility assessment and client support. Skilled in evaluating financial information to determine Medicaid qualifications while ensuring compliance with state regulations. Strong communicator dedicated to facilitating access to healthcare services and improving patient outcomes through effective collaboration.
Skills : Client-centric, Compassionate, Proficient In Medicaid Software And Case Management Systems, Outreach Strategies, Community Engagement, Stakeholder Communication
Description :
Maintains a consistent work schedule while managing caseload effectively.
Evaluates and verifies client income and resources to determine financial eligibility for Medicaid benefits.
Conducts thorough interviews with clients or representatives to gather essential information for eligibility determination.
Performs regular reviews to confirm eligibility status and benefit levels.
Processes updates to client records, including changes in status and benefit adjustments.
Documents case records meticulously using automated systems to ensure accurate client histories.
Facilitates communication with clients and stakeholders to address inquiries and resolve issues efficiently.
Experience
0-2 Years
Level
Fresher
Education
B.S. Health Admin.
Medicaid Specialist Resume
Summary : Accomplished Medicaid Specialist with a decade of experience in eligibility evaluation and case management. Expertise in navigating intricate Medicaid guidelines and fostering partnerships with healthcare providers to ensure seamless access to services. Committed to enhancing patient care outcomes through advocacy and meticulous compliance with regulatory standards.
Skills : Healthcare Billing, Time Management, Documentation Skills, Research Skills, Case Management, Financial Assessment
Description :
Conduct thorough assessments to determine resident eligibility for Medicaid benefits.
Complete and submit required Medicaid documentation to relevant authorities.
Manage Medicaid renewals by gathering necessary paperwork from families.
Collaborate with the Department of Public Welfare to process new and renewal applications.
Assist families in understanding medical benefits and services available to their loved ones.
Establish strong relationships with families, enhancing trust and communication.
Facilitate training sessions for new staff on Medicaid processes and compliance.
Experience
10+ Years
Level
Executive
Education
BSHA
Junior Medicaid Specialist Resume
Objective : As a Junior Medicaid Specialist with five years of experience, I excel in eligibility assessments and compliance verification. My background includes collaborating with healthcare providers to streamline service access and enhance patient outcomes. I am committed to upholding Medicaid regulations while ensuring effective communication and support for beneficiaries.
Skills : Negotiation Skills, Claims Processing, Data Entry And Management, Technical Proficiency
Description :
Maintains and updates the resident database to track authorizations, client obligations, and charges.
Adjusts accounts based on census data, cost-share agreements, and rates.
Reviews payments from State and MCOs for accuracy, collaborating with payers and caseworkers to rectify discrepancies.
Responds to inquiries from residents, families, and staff, ensuring timely communication and resolution.
Processes refunds for Medicaid residents efficiently, coordinating with State and MCOs.
Submits billing for multiple states through online platforms, ensuring compliance with regulations.
Handles internal and external phone inquiries, leveraging strong customer service skills.
Experience
2-5 Years
Level
Junior
Education
B.S. in Health Admin
Medicaid Specialist Resume
Objective : Compassionate Medicaid Specialist with two years of experience in eligibility evaluation and case management. Expert in navigating Medicaid regulations and ensuring compliance for diverse applicants. Proven ability to collaborate with healthcare providers and government bodies to enhance service access and improve patient outcomes through effective communication and support.
Process and review Medicaid applications for eligibility determination in compliance with state regulations.
Document all activities related to patient accounts for accurate record-keeping and follow-up.
Communicate with Medicaid representatives to verify payment statuses and resolve issues.
Review claims for accuracy, making necessary edits before resubmission.
Research and address patient inquiries regarding eligibility and services via phone and mail.
Analyze rejection reports to identify and rectify issues in claims submissions.
Maintain up-to-date knowledge of Medicaid policies and procedures to ensure compliance.
Experience
0-2 Years
Level
Junior
Education
B.S. in HA
Medicaid Specialist Resume
Objective : Results-driven Medicaid Specialist with two years of experience in eligibility assessments and compliance management. Demonstrates a strong capacity to analyze applicant information while ensuring adherence to Medicaid policies. Skilled at building partnerships with healthcare providers to streamline service delivery and enhance patient access to necessary resources.
Skills : Client Support, Patient Advocacy, Organizational Skills, Time Management Skills, Health Insurance Knowledge
Description :
Process all Medicaid claims, ensuring timely and accurate payments.
Conduct manual billing for third-party payers to secure reimbursements.
Maintain general ledger and prepare bi-weekly or monthly financial reports.
Monitor claims status using Novitas and Navint systems for pending issues.
Communicate with carriers to obtain pre-authorizations prior to patient visits.
Post payments to patient accounts, addressing uncollectible balances accordingly.
Organize and file documentation, including faxes and copies of all work performed daily.
Experience
0-2 Years
Level
Entry Level
Education
BSHA
Medicaid Eligibility Specialist III Resume
Summary : Dynamic Medicaid Eligibility Specialist with ten years of extensive experience in eligibility assessment and case management. Expert at navigating complex Medicaid regulations and ensuring compliance while facilitating access to essential services. Committed to enhancing patient outcomes through effective collaboration with healthcare partners and advocacy for vulnerable populations.
Collaborated with community partners to create referral networks, improving access to healthcare services.
Set and achieved departmental goals, consistently exceeding performance targets.
Maintained a focus on agency objectives, aligning individual performance with organizational goals.
Worked closely with team members to organize and implement strategic initiatives.
Demonstrated professionalism while interfacing with a diverse range of stakeholders.
Experience
10+ Years
Level
Senior
Education
B.S. Health Policy
Medicaid Eligibility Specialist/Executive Resume
Summary : Accomplished Medicaid Eligibility Specialist with 10 years of extensive experience in eligibility assessment and compliance management. Proven expertise in navigating complex Medicaid regulations and enhancing access to vital healthcare services. Committed to advocating for patients and improving outcomes through strategic collaboration with healthcare providers and government agencies.
Skills : Customer Service, Quality Assurance, Medicaid Enrollment, Fraud Detection, Crisis Intervention, Training And Development
Description :
Managed the Medicaid unit within the University of VA hospital, ensuring efficient service delivery.
Conducted eligibility interviews with patients and family members to gather critical financial information.
Collaborated with financial institutions and employers to verify patient eligibility.
Maintained confidentiality while interacting with sensitive patient information.
Partnered with hospital social workers and the admissions office for seamless service coordination.
Provided clear communication and support to patients throughout the eligibility process.
Analyzed trends in eligibility data to enhance service delivery and compliance.
Experience
10+ Years
Level
Senior
Education
B.S. Health Admin.
Medicaid Eligibility Specialist Resume
Summary : Dedicated Medicaid Specialist with extensive knowledge of Medicaid policies and procedures. Skilled in conducting eligibility assessments, resolving claims issues, and providing guidance to clients on benefits. Excellent communication and interpersonal skills, with a focus on building relationships with clients and healthcare professionals. Committed to improving access to healthcare for underserved populations.
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