Durham, North Carolina, United States · Hybrid
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Medicaid Eligibility Analysis, Financial Interviewing, Regulatory Compliance, Case Management, Bilingual Communication
Durham, North Carolina, United States · Hybrid
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Patient Assessment, Nursing Care Planning, Chronic Disease Management, Acute Care, Patient Education
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Professional Nursing Care, Patient Assessment, Care Management, Critical Thinking, Patient Education
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Pharmaceutical Care, Medication Therapy Management, Pharmacokinetics, Drug Information, Patient Education
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Registered nursing, Diagnostic radiology, Patient care, Acute care, MRI
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Professional Nursing Care, Patient Assessment, Nursing Process, Care Planning, Clinical Supervision
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Medication Administration, IV Fluids, Patient Assessment, BLS Certification, Clinical Documentation
Durham, North Carolina, United States · Remote OK
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Compliance Auditing, Medical Coding, HIPAA Compliance, Revenue Cycle Management, Internal Auditing
Durham, North Carolina, United States · Remote OK
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Inpatient Coding, Compliance Auditing, Medical Billing, Provider Education, Risk Analysis
Raleigh, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Administrative Support, EP Billing, EPIC Scheduling, Reporting, Supply Chain Management
Iredell County, North Carolina, United States · Remote OK
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Clinical Documentation Improvement, Medical Record Review, Case Management, Utilization Review, Critical Thinking
Chapel Hill, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Patient Care, Vital Signs Monitoring, EKG Performance, Medical Documentation, Phlebotomy
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Clinical Laboratory Testing, Specimen Handling, Instrumentation Calibration, Quality Control, Quality Assurance
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Patient Management, Physical Examinations, Diagnostic Procedures, Treatment Planning, Prescriptive Privileges
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Insurance Verification, Patient Registration, Financial Counseling, Medical Billing, Claims Resolution
Durham, North Carolina, United States · On-site
$64k–$103k/yr
School of Medicine Established in 1930, Duke University School of Medicine is the youngest of the nation's top medical schools. Ranked sixth among medical schools in the nation, the School takes pride in being an inclusi…
Skills: Clinical Research Coordination, Patient Consent, Data Collection, Regulatory Compliance, IV Insertion
Durham, North Carolina, United States · On-site
$18/hr–$26/hr
School of Medicine Established in 1930, Duke University School of Medicine is the youngest of the nation's top medical schools. Ranked sixth among medical schools in the nation, the School takes pride in being an inclusi…
Skills: In Vivo Experiments, Mouse Colony Maintenance, Cell Culture, Tissue Staining, Sample Processing
Durham, North Carolina, United States · On-site
$20/hr–$32/hr
Duke University: Duke University was created in 1924 through an indenture of trust by James Buchanan Duke. Today, Duke is regarded as one of America’s leading research universities. Located in Durham, North Carolina, Duk…
Skills: Payroll Administration, HR Transaction Processing, Recruitment, Onboarding, SuccessFactors
Durham, North Carolina, United States · On-site
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advanc…
Skills: Physical Examinations, Patient Care, Diagnostic Procedures, Treatment Planning, Medical Documentation
Durham, North Carolina, United States · Hybrid
$60k–$89k/yr
School of Medicine Established in 1930, Duke University School of Medicine is the youngest of the nation's top medical schools. Ranked sixth among medical schools in the nation, the School takes pride in being an inclusi…
Skills: Administrative coordination, Financial management, Budgeting, Data management, Event planning
Durham, North Carolina, United States • Hybrid
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Coordinate and facilitate the Medicaid application process to obtain eligibility and reimbursement for patients. This includes conducting in-depth financial interviews, representing patients in administrative hearings, and collaborating with the Department of Social Services.
Requires a Bachelor's degree in business, healthcare administration, accounting, finance, or a related field. A minimum of four years of related experience is required, and bilingual skills are strongly preferred.
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
This is a hybrid remote position working between 1-4 days a week remotely depending on the needs of the department
Monday - Friday 8:00am - 5:00pm
Conduct thorough, in-depth interviews and evaluate patient’s case for potential eligibility for Medical Assistance Programs and any applicable Purchase of Medical Care programs.
Analysis of patient’s assets, income, clinical history, and dependent responsibilities, must be conducted in a precise manner based on knowledge and interpretation of the federal regulations and Social Security Administration guidelines. Assess patient’s continuing care needs and determine correct program and certification period to minimize patient deductible and maximize entity reimbursement.
Communicate and advise patients on complex financial concepts and procedures of applying for Medicaid. In some cases, may act as the authorized patient’s representative for the purpose of initiating an application for benefits and for conducting any and all activities associated with determination of eligibility of benefits, including the initiation and conduct of administrative and /or judicial appeals. There is legal liability involved for the Medicaid Eligibility Analyst, as they are responsible to the county/state for the accuracy of information and actions taken on behalf of the patient. The Medicaid Eligibility Analyst has the ability to act for the individual and exercise the individual’s rights.
Coordinate and facilitate the completion of the Medicaid application. Gather and provide necessary verifications to establish Medicaid eligibility via direct contact with patient and/or patient’s family, employer, financial institution, vital statistics and other collaterals to the County Department of Social Services Income Maintenance Caseworker in the county of patient residency.
Follow-up with patient and the Department of Social Services to ensure all pertinent information has been provided relevant to the Medicaid application. This may require travel to county of patient residency for the purpose of transporting the patient to the Department of Social services for follow-up visits, obtaining additional records, and verifying or correcting information on behalf of the patient. Anticipate and troubleshoot logistic and compliance barriers.
Evaluate case files to determine issues and sufficiency of evidence or documentation, analyzing Social Security Administration rules, Division of Medical Assistance guidelines and relevant regulations for applicability. Initiate fact finding, research in support or denial of case merit. Based on findings, evaluate if challenge is appropriate and facilitate the request for a hearing from the responsible local agency or State Office of Hearings and Appeals if warranted.
Prepare hearing briefs, assemble documentary evidence and exhibits to represent the patient at local agency, State and Chief Hearing Officer hearings for the purpose of reversing a negative decision with or without the patient’s assistance. Interview, evaluate and prepare potential witnesses for substantive evidence in support of the decision reversal. Present patient
case, examine and cross examine witness, and enter evidence into the case file at adjudication hearings to establish patient’s eligibility for Medicaid.
Responsible for entering pertinent information into the hospital system and closely monitoring authorization dates and deductible amounts applied to patient accounts.
Reconcile account financial status coding monthly to ensure accounts are represented accurately.
Serve as an educational resource on Medicaid issues for patients, Social Workers, Physicians, Clinic and Admissions personnel.
Review and monitor revisions in policy/regulations for all Medicaid programs on a regular basis to determine the effect of these revisions on pending applications.
Perform other related duties incidental to the work described herein.
The Medicaid Eligibility Analyst is required to meet the following performance standards on a monthly basis:
Excellent communication skills, oral and written.
Managing sense of complex, high quantity, and sometimes contradictory information to effectively solve problems, while making good and timely decisions that keep the organization moving forward.
Ability to actively learn when facing new situations, adapt quickly and positively to change, perform multiple tasks and work independently.
Must be able to work collaboratively with others to meet shared objectives while maintaining professional, service-oriented working relationships with key stakeholders such as patients, physicians, case managers/social workers, co-workers, supervisors, and representatives at Department of Social Services/Department of Disability Services.
Shares own ideas/viewpoint in a compelling manner and negotiates skillfully when working toward an agreed solution or common goal.
Ability to engage with individuals in their feeling, capabilities, and perspectives in order to best meet and anticipate their needs.
Collaborate with others to promote cooperation and commitment within a team to achieve goals and deliverables. Must be able to understand, interpret, and comply with Duke Health and Medicaid policies and procedures.
Distinguishing Characteristics of this Level:
Position responsible for high production generated accurately in accordance with established business processes or regulation. Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Duke Health Technology Solutions is a robust, specialized division of Duke University Health System dedicated to the development and management of enterprise IT systems. A 2018 Davies Award Recipient, Duke Health is nationally recognized for IT and information management as the first healthcare system to be awarded top honors by the Healthcare Information and Management Systems Society (HIMSS) for inpatient, ambulatory and analytics health information technology capabilities. As a ‘Most Wired’ health system, our employees are among the top-skilled IT experts in the Triangle and work with leading scholars and researchers across Duke University to develop innovative technologies that support our mission of delivering tomorrow's healthcare today.
Offices: 2424 Erwin Road, Durham, NC 27715, US
View all jobs at Duke Health Technology SolutionsDuke Health Technology Solutions is a robust, specialized division of Duke University Health System dedicated to the development and management of enterprise IT systems. A 2018 Davies Award Recipient, Duke Health is nationally recognized for IT and information management as the first healthcare system to be awarded top honors by the Healthcare Information and Management Systems Society (HIMSS) for inpatient, ambulatory and analytics health information technology capabilities. As a ‘Most Wired’ health system, our employees are among the top-skilled IT experts in the Triangle and work with leading scholars and researchers across Duke University to develop innovative technologies that support our mission of delivering tomorrow's healthcare today.
Offices: 2424 Erwin Road, Durham, NC 27715, US
View all jobs at Duke Health Technology Solutions