Medicaid Specialist Resume Samples

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.

 

Medicaid Specialist Resume example

Medicaid Specialist Resume

Headline : Administrative professional with diversified experiences in advising, program development, document control, office administration, consulting, higher education, adult & 9th-12th education, teaching/learning, analysis, teamwork, and quality improvement techniques.

Skills : Microsoft Office And Word.

Description :

    1. Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region.
    2. Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.
    3. Determines applicant's eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants' applications.
    4. Maintains effective public relations with medical facilities and federal, state, county and city agencies within assigned territory.
    5. Verifies accuracy of information listed on applicants' applications including income, bank accounts, and any other assets.
    6. Makes determination of an applicant's eligibility based upon established criteria.
    7. Visits contact centers and medical facilities: assist other Regional Offices on an as-needed basis.
    8. Performs related or similar duties as required or assigned.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
BA In English


Sr. Medicaid Specialist Resume

Summary : To secure a position with a well established organization as well as a stable environment that will lead to a lasting relationship in the field administrative assistant, medical records billing, or social services, which will also enable to use strong organizational skills, educational background, and ability to work well with others.

Skills : Excel, Power point, Faxing, Multi-phone System, Medicaid Billing, Microsoft Word.

Description :

    1. Explains the program and advises patients of methods to become eligible by rearranging finances and assets.
    2. Processes changes to patient status, obtains, verifies, and calculates income and resources to determine client financial eligibility.
    3. Documents case records using automated equipment to form a record for each client through Point Click Care, PCC.
    4. identification of all pending/recertification files, forms, timely completion Options/51 which include PASRR II assessments for Medicaid eligibility.
    5. Recertification documentation and tracking the status of open pending Medicaid applications.
    6. Follows through with applicants to obtain accurate and complete information within strict timeframes.
    7. Reviews denials, troubleshoots previously denied files including obtaining previously unattained documentation, including advising on appeal processes and time restraints attached to appeal limits per state protocol.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Medical Management


Jr. Medicaid Specialist Resume

Objective : To find employment with a company where skills and experience will be an asset and to gain additional experience in the process.

Skills : Microsoft Office, Word, Excel, Power Point.

Description :

    1. Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region.
    2. Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.
    3. Determines an applicant's eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants' applications.
    4. Maintained effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory.
    5. Verifies accuracy of information listed on applicants' applications including income, bank accounts, and any other assets.
    6. Makes determination of an applicant's eligibility based upon established criteria.
    7. Visits contact centers and medical facilities; assists other Regional Offices on an as-needed basis.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's In Sociology

Medicaid Specialist III Resume

Objective : To acquire a position which will offer an array of business growth opportunities and administrative practice where skills can be fully utilized in a career in business and office technology.

Skills : Microsoft Office and Word.

Description :

    1. Determine Medicaid eligibility for an assigned caseload for clients in Simpson, Smith, and Rankin County.
    2. Contact clients and verify accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.
    3. Determine a client's eligibility based on State and Federal guidelines and confirm the accuracy of information provided on the clients' applications.
    4. Maintain contact with hospitals for patient verification and federal, state, county, and city agencies within assigned territory.
    5. Verifies accuracy of information listed on clients' applications including wages, bank account information, and any other important information.
    6. Determine client's eligibility based upon established criteria.
    7. Contact regional offices on an as-need basis.
    8. Travel to outstation locations to assist clients on a monthly basis.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
B.A. In Psychology

Medicaid Specialist II Resume

Objective : To obtain a position with your company that will enable to use strong organizational skills, management, and educational background and ability to work well with people.

Skills : Excel, Microsoft Office, Microsoft Outlook, PowerPoint, Oracle, AS-400.

Description :

    1. Responsible for Medicaid eligibility determination case loads for a designated territory.
    2. Verify accuracy of information listed on applicants' applications including income, bank accounts, and any other assets.
    3. Determine applicant's eligibility based upon established criteria.
    4. Maintain effective public relations with medical facilities and federal, state, county, and city agencies with assigned territory.
    5. Assist the Medicaid Specialist Supervisor with the training of new Medicaid Specialists and new clerical employees.
    6. Assist the Medicaid Specialist Supervisor with the overall evaluation of the eligibility program and determining initial and ongoing eligibility for Medicaid applicants and recipients.
    7. Maintain a caseload of active cases and perform related or similar duties as required or assigned by the Medicaid Specialist Supervisor.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BA In Business

Medicaid Specialist I Resume

Objective : Looking for a position as an Medicaid Specialist, Human Resources Assistant/Specialist and/or Payroll Assistant to utilize experience, skills and training in your organization.

Skills : Computer, Leadership.

Description :

    1. State-funded agency providing Medicaid and food stamp benefits.
    2. Delineated guidelines and requirements, reviewing medical documentation and performing intake assessments.
    3. Reviewed state and federal resource and income data, guaranteeing regulatory compliance.
    4. Coached and counseled staff members developing unit competencies.
    5. Departmental lead consultant for pilot Medicaid buy-in program.
    6. Case management HIPAA knowledge Working with clients.
    7. Billed, and followed up on denial management of Medicaid claims Maintained all Medicaid accounts receivable aging Checked status of Medicaid pending accounts Completed and maintenance state required forms.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Business Administration

Medicaid Specialist/Analyst Resume

Summary : Outgoing and dynamically positive individual with six years of experience. Skilled in delivering key points of information to a diverse group of people.

Skills : Micrsoft Word & Excel.

Description :

    1. Responsible for development of information and handouts for staff and provider training, as well as bureau staff meetings.
    2. Interacts with governmental agencies, elected public officials, private organizations, and the general public in executing projects assignments.
    3. Assist with Legislative reports and statistical reports required for budgeting.
    4. Complete subsystem edits reports and provider correspondence.
    5. Communicate policies, procedures, and federal / state regulations related to the agency.
    6. Complete onsite assessment at potential and current provider's facilities.
    7. Consults with administrators, program directors, and staff at all levels concerning planning, evaluation, manage project objectives; determines data collection and analysis procedures, and develops work plan and time tables to meet deadlines.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Medical Assistant

Medicaid Specialist/Representative Resume

Headline : To obtain a position that offers professionalism, ability to perform strong management skills in order to provide patients with the top-notch services.

Skills : Dedicated, Supportive, Motivated as well as proficient in using the varied computer systems and software., Phlebotomy.

Description :

    1. Maintains a regular and predictable work schedule.
    2. Obtains, verifies, and calculates income and resources to determine client financial eligibility.
    3. Interviews clients or authorized representative to gather information to determine eligibility for benefits.
    4. Conducts reviews to determine or verify eligibility or eligibility and benefit level.
    5. Processes changes to client status, overpayments, and adjusts or restores benefits.
    6. Documents case records using automated equipment to form a record for each client.
    7. Communicates on an intermediate level with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints.
    8. Works with clients and/or OSS Workers to attempt resolution of disputed case actions.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma In Business

Medicaid Specialist/Executive Resume

Objective : Billing for Medicare A and B, Medicaid and Managed Care Insurances and private statements. Entry of all ancillaries charges that pertain to a 90 Medicare certified facility. Personal contact either by phone or in person with residents and families pertaining to questions with private statements.

Skills : Micrsoft word & excel.

Description :

    1. Meet with families to get information about the resident's eligibility for Medicaid benefits.
    2. Fill out required Medicaid forms, submit to the Department of Public Welfare.
    3. Responsible for all Medicaid renewals - meet with families to get the required paperwork to continue Medicaid benefits.
    4. Submit all paperwork and work with Depth. of Public Welfare to renew current benefits or get new benefits.
    5. Work with families to sign in short and long term residents.
    6. Helping families go over medical benefits for loved ones and the appreciation you get from families for helping them.
    7. Created great relationships with the Dept.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Business Administration

Associate Medicaid Specialist Resume

Objective : To obtain an entry-level position in an office environment that will utilize current knowledge in health bioinformatics and exemplary customer service skills and that will encourage growth.

Skills : Customer Service, Medicaid, Medical Billing, Administrative Support, Accounts Receivable.

Description :

    1. Maintains resident database for tracking authorizations, client obligation and charges.
    2. Makes adjustments to the account based on census, cost-share and rates.
    3. Reviews payments from State and MCO's for accuracy; corresponds with payers, communities, and caseworkers to correct or modify payments received.
    4. Researches communicate and respond to inquiries from residents, family members, field staff and other departments.
    5. Researches and processes refunds for Medicaid residents, State and MCO's.
    6. Submits billing for multiple states through websites.
    7. Answer internal and external phone lines with the strong customer service experience.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Medical

Asst. Medicaid Specialist Resume

Summary : Strong computer skills with proficiency in Windows, Microsoft Excel, Word, Access and PowerPoint.

Skills : Powerpoint, Excel, Access, Etc.

Description :

    1. Correct all claims that denied in HP in a timely manner.
    2. Documents all activity on the patient's account for referen ce and follow-up.
    3. Receives incoming correspondence associated with billing.
    4. Contacts Medicaid to determine processing of payment.
    5. Review claims for accuracy, perform required edits, submits and rebill accounts.
    6. Research and respond to incoming patient inquires by phone and mail.
    7. Review rejection report to determine information needed to complete the billing or claim submission process.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Human Services

Medicaid Specialist Resume

Summary : Over 10 years insurance experience. Knowledgeable with various software. Such as Microsoft word,excel.and outlook. Universal billing.Medicare. Used 1500 form billing secondary carriers. Well as UB92,94 and EOB MEOB itemize billed. Additional experience with deliquence accounts, billed on overdue payment. Problem solve,troubleshoot,expedit situation quickly and professionally.

Skills : Bathing, Feeding, House Cleaning,and Run Errands.

Description :

    1. Process all Medicaid claims for payment.
    2. Well as manual billing third parties for payment.
    3. Responsible for general ledger with bi-weekly or monthly report.
    4. Checked status on claims on Novitas system and Navint system for pending claims.
    5. Called various carriers for pre-authorization before visted.
    6. Posted payment to patient accounts, write off any uncollectible balances.
    7. Additional files, faxes, and copies of all work daily.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Certified In Nursing