Utilizing a high-level of customer service, healthcare finance knowledge, and excellent communication skills, the Family Financial Medicaid Specialist will work directly with families to assist in applying for appropriate state Medicaid programs as well as Marketplace plans. This bi-lingual preferred position requires face to face and phone interviewing of families to facilitate enrollment for those meeting income/disabled children's Medicaid requirements. The Specialist will assist with streamlining enrollment by gathering, assembling, reviewing and submitting sensitive information supplied by applicants. The Medicaid Specialist will also educate the family on financial assistance programs offered by Nemours and communicate the financial aspects of seeking treatment at Nemours. This is a flexible position which requires assisting various teams within Family Financial Services as business need dictate.

This position may also work with insurance verification personnel to determine benefit level, coordination of benefits, coinsurance and deductible amounts and communicate financial obligations to the guarantor. This role will be responsible for determining a suitable financial assistance program for each family identified as being in need, developing payment arrangements, collecting prepayments (deposits and out of pocket costs), and approving discounts in accordance with organizational and government policies.

In addition to providing financial assistance and resources, the Family Financial Medicaid Specialist may research and address a broad range of inquiries covering items such as insurance regulation and processing protocols, charge discrepancies, benefit interpretation and adjudication. This position requires travel to other Nemours service locations such as Primary Care offices, Specialty Care sites, and any other locations deemed necessary by management to assist families face to face with Medicaid enrollment.

Position Responsibilities

• Customer Service: Convey courtesy, dignity, respect and a positive attitude through words and actions to establish harmonious relationships with all individuals. Demonstrate effective communication and respect by using active listening skills, positive body language and effective verbal, written and electronic forms of communication. Demonstrate care and concern and inclusion when interacting with and informing customers by consistently using A.I.D.E.T and protecting confidentiality and privacy.
• Utilize daily work queues, reports and schedules to identify and make contact with underinsured/uninsured patients to assist them in meeting their financial obligations for care by applying internal policies/procedures and external resources.
• Interview patients/families to obtain comprehensive financial information and based on this information, advise them on available financial assistance programs and assist them with applications and/or enrollments in Medicaid and Marketplace programs.
• Respond timely and appropriately to all internal referral requests and external customer phone calls to ensure that all issues are resolved in accordance with departmental standard workflows. This includes but is not limited to; referrals for new Medicaid enrollment assistance, follow-up on outstanding applications, coordinate charity care applications with the Financial Services team, offer and set up payment plans, and special projects such as researching high dollar and newborn accounts.
• Collaborate with Authorization and Verification department to identify self-pay families who might qualify for Medicaid programs and ensure contact with families to complete their enrollment.
• Meet daily/weekly/monthly goals and expectations: Medicaid enrollment, Charity Care programs, Marketplace Place enrollment, Disabled Children's Medicaid Applications, and all processes associated with each program.
• Ensure that Medicaid and Charity Care enrollments, payment plans, discounts, and receipt of payments are accurately assigned to accounts and properly documented.
• Utilize scheduling templates appropriately and request adjustments when necessary to ensure adequate access is available for our families. Face-to-face encounters with patients/families, including walk-ins, should be scheduled.

Position Requirements

• 1 year of training beyond High School Diploma; Associate degree Preferred
• Bi-lingual. Spanish Required
• EPIC software application knowledge or certification helpful
• CHAA (Certified Healthcare Access Associate), CRCR (Certified Revenue Cycle Representative) or CAC (Certified Application Counselor) preferred
• 2-3 years Customer Service and healthcare insurance verification and billing.
• Minimum 3 years clerical experience in healthcare setting such as physician office or hospital admissions.
• 1-2 years' experience in Medicaid enrollment and/or Financial Counseling