- The Enrollment Specialist is responsible to financially assess the unfunded patients for Medicaid, State, Federal and JHS eligibility programs, and refer to appropriate entity.
- The incumbent's responsibilities include becoming the Designated Authorized Representative for the patient during the application process; interviewing the patient or family for complete and correct information to be given in the application package; attending the DCF interview on the patients behalf; and gathering all required information needed to bring the patients enrollment application to a positive and timely dis.
- The Medicaid Specialist works collaboratively with family members, Ancillary Departments, and coordinates with State and Federal entities as the facilitator of the patients financial determination.
- Update the applicable systems with application information as needed.
- Assures that the assigned goals and objectives are met.
- Assesses the hospitals unfunded patients for enrollment in State, Federal and JHS eligibility programs in all outpatient and inpatient arenas.
- Conducts interviews with patients and /or families to compile, organize, review and evaluate information and ensure its accuracy, prior to submitting a completed eligibility application package.
- Completes equal distribution of daily case assignments .
- Completes the Medifax/ Credit reporting process for all patients applying for State, Federal or JHS programs.
- Follow the appropriate process based on the information received from the Medicaid result. Serves as an Authorized Representative/Liaison for the patient to Department of Children and Families Services and Social Security Administration. Informs and instructs patients on pending documents to be submitted for all eligibility programs.
- Attends DCF interviews, as required, as the Designated Authorized Representative and follows up with the patient to secure any additional information if needed. Follow ups with DCF, DDD and SSA on all referrals in which the Jackson Health System is not the Designated Authorized Representative to ensure that the patient is interviewed by DCF and returns pending information if needed.
- Participates fully and consistently as a team member in caring for the children and in the overall operation of the program and center; maintains open communication and works collaboratively with interdisciplinary staff, parents/legal guardians, and/other community resources/agencies.
- Solicits and obtains additional evidence through interview and research of the affected patient or as requested by the ODD.
- Works collaboratively with patient/family, medical personnel, social workers, and other ancillary departments to assess patients medical, social and economic status. Assists in the resolution of problems and promotes a positive relationship between all departments and agencies.
- Answers all inquires from Managers, Supervisors, patients and patients families regarding the patients application.
- Maintains records, including processing documentation necessary to ensure follow up throughout the course of the application determination process.
- Maintains thorough knowledge of all systems required to facilitate the application process.
- Prepares and maintains statistical data and submits weekly/monthly productivity reports on activities and performance pertaining to the application process.
- Identifies external correction initiatives, and participates in the work plan to resolve areas cited for improvement.
- Maintains current knowledge of various funding programs such as CMS, Social Security, SSI, DVT, and others as indicated and necessary in the processing of benefits Relates and interacts well with others relative to their age specific, physical and psychosocial needs.
- Follow Organization-Wide and Unit specific safety, security and infection Control Standards.
- Participates in Continuing Quality Improvement activities to ensure continuous improvement of services provided.
- Respect the rights and privacy of patients to ensure that all HIPPA Guidelines are adhered to.
- Attends appropriate orientation and training courses to maintain competency in Job skills and Knowledge.
- Participates in required educational programs.
- Educate patients on Jackson Health Systems physicians and clinics.
- Educate patients on Managed Care Medicaid and any other JHS , State or Federal products.
- Performs other related duties as assigned Adhere to the Standards of Excellence at all times.
- Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
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Enrollment Specialist, Uncompensated Care, Full Time, Days - Miami, United States - Jackson Health
Description
Department: Uncompensated Care
Address: 1611 NW 12th Ave, Miami, FL 33136
Shift Details: Full Time, Days
Why Jackson:
Holtz Children's Hospital at the University of Miami/Jackson Memorial Medical Center is one of the largest pediatric hospitals in the southeast United States, where UHealth - University of Miami Health System physicians treat children from throughout Florida and the Caribbean. Holtz Children's is known worldwide for its care of critically ill newborns in its neonatal intensive care unit, which is one of the largest in the United States and boasts some of the best medical outcomes. In collaboration with the Miami Transplant Institute, Holtz Children's is one of only three centers in the country that specializes in pediatric multi-organ transplants. It is home to one of only three state-accredited comprehensive children's kidney failure centers and one of the largest pediatric kidney transplant programs in the world. The Children's Heart Center at Holtz Children's is the only comprehensive children's heart program in South Florida. In partnership with the University of Miami, Holtz Children's also trains the most pediatric physicians of any medical center in the southeastern United States.
Position Summary:
Duties & Responsibilities:
Experience:
Generally requires 3 to 5 years of related experience.
Education:
High school Diploma is Required.
Bachelor's Degree in related field is strongly preferred.
License Certification:
Valid License or Certification is Required as needed, based on the job or specialty.
Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.
