Medical Eligibility Counselor (CHI Memorial Hospital - Georgia) Full-Time

1800000934 Requisition #
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Job Purpose


Arranges an efficient and effective interview process to screen patients for Medicaid eligibility and/or eligibility for other assistance programs, acting as a liaison with State Medicaid Programs.  Coordinates, develops and maintains the financial screening for patients presenting for services at CHI Memorial Hospital Georgia (CHIMHG) including; all accident payers, insurance companies, employers, auto liens, charity care programs, collection of up-front deposits/co-payments, payroll deduction, and other related financial services.  Reviews accounts Medicaid accounts to resolve any billing edits, seeking assistance from the Business Office Supervisor as needed.


Duties & Responsibilities

  Medical Eligibility Screening/Charity Care

·         Assist all patients with eligibility for programs including Medicaid, HCAP and Charity.

·         Conducts patient interviews gathering pertinent information and documentation to assist with traditional, presumptive and disability eligibility.

·         Uses all tools and systems to screen patients for eligibility.

·         Runs reports to identify uninsured patients and screen for eligibility via phone post discharge.

·         Runs reports to follow-up with patients/programs to determine status of application.

·         Conducts/arranges all financial assistance requests of patients/customers.

·         Screens applications/requests for assistance and determines eligibility based on appropriate guidelines.

·         Processes all scheduled/non-scheduled requests for assistance.

·         Assist patients with applications to programs/resources including Department of Medical Assistance, Social Security, or Social Security Disability programs as appropriate.

·         Refers all completed Financial Assistance applications to Registration Supervisor for processing.


   Insurance Billing Edits

·         Reviews list of Medicaid insurance billing edits and takes appropriate action to resolve edit according to payer specifications.

·         Performs accurate and timely billing follow-up to all Medicaid payers.

·         Monitors unpaid claims work list to ensure prompt resolution.

·         Maintains control of accounts to ensure that reimbursement is received and there is no loss due to errors of omission or commission.

·         Receives and processes Medicaid insurance denials.

·         Determines if denial is appealable and takes appropriate action to file the appeal.


  Other Duties

·         Attends/participates in departmental staff meetings, serves on hospital/departmental committees.

·         Attends required education seminars/training sessions.

·         Alters regularly assigned work schedule as requested/required.

·         Maintains daily productivity logs.

·         Monitors scheduled hours worked to prevent overtime.

·         Protects the financial integrity of the department and CHIMHG by using supplies efficiently.

·         Monitors transactions pertaining to the financial areas and informs coworkers, registration staff and management as necessary.



  • Associate Degree, or equal amount of related experience
  • Two or more years’ experience in a healthcare setting dealing with financial status of individuals.
  • Department of Human Services screening experience required
  • ACA experience preferred.
Specialized Skills:                             
  • Data entry, computer and communication skills, general clerical skills.
  • Medical terminology coursework or knowledge required.
  • Positive service-oriented interpersonal and communication skills.
  • Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient. 
  • Individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to evaluate data reflection of the patient status.
  • Interpret the appropriate information needed to identify each patient’s requirements relative to their age-specific needs and to provide the care needed as described in the facilities policies and procedures.

Equipment, Machines, Tools Used:  

  • Computer, calculator, fax, copy machine, adding machine.

Additional Responsibilities:

  • Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
  • Adheres to and exhibits our core values:
  • Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
  • Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
  • Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
  • Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
  • Maintains confidentiality and protects sensitive data at all times.
  • Adheres to organizational and department specific safety standards and guidelines.
  • Works collaboratively and supports efforts of team members.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers
This position requires a criminal background check.  Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

About Us

Chances are, you’re here because you’re looking for a career offering greater opportunity, challenge and fulfillment. We’re confident you’ll find all three at CHI. As one of the nation’s largest nonprofit health systems, we offer a wealth of careers across more than 101 hospitals in 18 states. Our faith-based health system welcomes you to share in our mission of building healthier communities, whether as a surgeon in the operating room or an administrator in a conference room. When you work in a supportive environment with like-minded professionals, wonderful things happen. Learn More

Equal Opportunity Employment

Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employement without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disabilitiy or any other legally protected characteristic. 

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