The purpose of this position is to secure reimbursement for services rendered to uninsured and/or underinsured patients by assisting individuals in accessing and/or applying for any Medicaid or other Federal or State assistance programs, or for other forms of sponsorship for which they might qualify.  The result of this activity is new and continued reimbursement for medical care services.  Performs requirements for staff members as outlined in Compliance Roles and Responsibilities in OHSU Hospitals and Clinics.

• Conducts on-site Medicaid program intakes in both English and Spanish, forwarding applications and supporting documentation to appropriate Medicaid office, Aging and People with Disabilities office (APD), and other state Department of Human Services (DHS) offices as appropriate. 
• Assists potential eligible clients or their representatives in the application process with the appropriate public assistance office, monitoring, advising, interviewing and advocating as appropriate throughout the application process from initial application through formal decision. 
• Monitors decisions of approval to ensure accuracy of program and medical effective date and decisions of denial assuring appropriateness of agency action. 
• Counsels referred patients delineating State medical coverage versus personal liability.  
• Assesses patients for waivered or placement services, coordinating the process with OHSU Care Management, Medicaid agency staff and providers of the waivered services or nursing home placement staff for successful and timely discharges for inpatients and service plan and placements post discharge. 
• Evaluates and advises patients and family members in accessing hospital and community services by consulting and making referrals to social workers, patient care coordinators, nursing home liaisons, outside agencies and legal services.
• When information gathered discloses that a patient has insurance, gathers information, codes and transfers account to the Insurance Verification Specialists for insurance verification and authorization. 
• For patients/guarantors disclosing difficulty in paying their bill, and after assessing all other possible funding sources such as COBRA, Medicaid, etc., initiates application under the OHSU Financial Allowance Policy. 
• Provides assistance to other internal and external eligibility staff and to miscellaneous hospital staff regarding Oregon Medicaid programs administered through DHS; provides interpretation of the state’s DHS computer screens; provides assistance regarding programs of the Social Security Administration. 
• Provides assistance related to managed care, indemnity plans, Medicare and other insurance plans.
• Actively identifies, on a continuous basis, Medicaid program changes, problematic policy issues and procedural requirements relative to state and federal programs that impact patients and the hospital.   
• Other duties as assigned.

• A minimum of one year of recent experience in determining Medicaid eligibility; OR

• Three years of any combination of determining eligibility for public assistance programs. Recent experience is defined as within the last five years.

• An undergraduate degree will substitute for one years of Medicaid experience.

• Preference is given to applicants who have experience determining eligibility for Medicaid applicants/recipients.

Knowledge, Skills, and Abilities

• Extensive knowledge of statutes, regulations, policies, procedures and guidelines of assistance programs administered by DHS agencies and the Social Security Administration as well as community programs available to patients in need.
• Extensive knowledge regarding confidentiality, privileged communication and professional ethics, including advocacy techniques.
• Extensive knowledge of the Medicaid eligibility systems and other information systems, personal computers and office equipment.  Knowledge of medical terminology.
• Skill in interpreting and applying Federal & State rules and regulations, policies and procedures for Medicaid, disability programs & Health Insurance Portability and Accountability Act (HIPAA).
• Skill in casework methods and techniques including communication with and assessing the needs of individuals with physical and mental disabilities, the elderly and disease processes. 
• Skill in verbal and written communication with patients/clients and collateral resources of various socioeconomic backgrounds.
• Skill in prioritizing and managing work time and efforts to accomplish both ongoing and emergent duties.  Skill in maintaining composure and working objectively with patients/clients who may be hostile or verbally abusive.
• Skill in maintaining harmonious working relationships.
• Must have demonstrable record of reliable attendance, exemplary customer contact skills, punctuality, and proven successful performance at most recent past and present employers.

Certifications

• Must complete certification as a Medicaid Application Assister (for both Oregon and Washington) within 3 months of employment, which includes a background check through the State of Oregon. Must be able to maintain certification annually.

• Certificate of Successful completion in Spanish Language, issued by OHSU Translation and Interpreter Services Department’s current process.

• Undergraduate Degree.
• A minimum of three years of recent experience in determining Medicaid eligibility.

Hybrid remote, Monday - Friday, 9:30am - 6:00pm. Work from home days must be Tuesdays, Wednesdays, or Thursdays.

 

Regular contact with patients both in office and in a clinical setting.

Occasional contact with hostile or angry patients or family members.

 

Benefits

• Healthcare for full-time employees covered 100% and 88% for dependents.

• $50K of term life insurance provided at no cost to the employee.

• Two separate above market pension plans to choose from.

• Vacation - up to 200 hours per year dependent on length of service.

• Sick Leave - up to 96 hours per year.

• 9 paid holidays per year.

• Substantial Tri-Met and C-Tran discounts.

• Employee Assistance Program.

• Childcare service discounts.

• Tuition reimbursement.

• Employee discounts to local and national businesses.

We are Oregon's only public academic health center.

In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.

All are welcome.

OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply.

To request reasonable accommodation, contact askhr@ohsu.edu