Duke University · 1 month ago
Medicaid Eligibility Analyst
Durham, NC, US, 27710
Full-time
Hybrid
Mid Level
4+ years expDuke University is a leading health institution committed to compassionate care. They are seeking a Medicaid Eligibility Analyst to coordinate the Medicaid application process, ensuring patients receive the necessary support for eligibility and reimbursement for services provided by the health system.
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Responsibilities
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
Qualification
Required
Bachelor's degree in business, healthcare administration, accounting, finance or a related field is required
Four years of related experience is required
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
Preferred
Bilingual strongly preferred
Company
Duke University
Duke University is a private research university providing undergraduate and postgraduate education in medicine and other disciplines.
10001+ employees
H1B Sponsorship
Duke University has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (274)
2024 (232)
2023 (202)
2022 (195)
2021 (148)
2020 (121)
Funding
Current Stage
Late StageTotal Funding
$71.15MKey Investors
North Carolina Biotechnology CenterUS Department of EnergyGlaucoma Research Foundation
2023-02-17Grant· $0.11M
2022-09-19Grant
2022-03-09Grant· $0.05M
Leadership Team
Barry Myers
Professor and Director
Dan Ariely
Professor
Recent News
2026-01-11
2025-12-18
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