Medicaid Redetermination Specialist

Elevate Patient Financial Solutions has an exciting career opportunity available as a Medicaid Redetermination Specialist position in our Referral Management and Analytics Department. This position will be based in a hospital in St. Louis, MO. The Full-Time schedule for this role will be 8:00 AM-5:00 PM, Monday-Friday with flexibility as needed.

Job Summary

The Medicaid Redetermination Specialist is an employee of Elevate Patient Financial Solutions who functions as a representative of the Missouri Medicaid program. The position is responsible for processing Medicaid redetermination applications, reviewing eligibility information, maintaining compliance with state and federal regulations, and assisting with the continuation of healthcare coverage for eligible Missouri Medicaid beneficiaries.

Working onsite at the applicable facility, the Specialist uses Missouri state eligibility systems to review, process, and complete redetermination activities accurately and on time. The role requires attention to detail, strong organizational skills, and the ability to work within strict regulatory guidelines while protecting the confidentiality of protected health information.

Essential Duties and Responsibilities

Process Medicaid redetermination applications using Missouri Medicaid eligibility systems. Review applications and supporting documentation to determine completeness and eligibility requirements. Verify demographic, financial, household, and insurance information according to established state guidelines. Identify missing information and follow established procedures to obtain required documentation.

Monitor assigned caseloads and ensure timely completion of redetermination activities. Document case actions, determinations, and follow-up activities accurately within state systems. Maintain compliance with Missouri Medicaid policies, procedures, and program requirements. Collaborate with state personnel, hospital staff, and other stakeholders as appropriate.

Protect confidential patient and member information in accordance with HIPAA and applicable state regulations. Meet productivity, quality, and accuracy standards established by Elevate and the Missouri Medicaid program. Participate in required training, quality reviews, and process improvement initiatives. Assist with special projects and additional eligibility-related activities as assigned.

Regular and timely attendance. Other duties as assigned.

Qualifications

and Requirements To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities. High School Diploma or GED Experience in healthcare eligibility, Medicaid, public assistance programs, insurance verification, patient advocacy, financial counseling, case management, or a related field (minimum of one (1) year preferred) Experience working with government benefit programs or eligibility determination processes preferred Knowledge of Medicaid eligibility requirements and redetermination processes preferred Previous experience with Missouri Medicaid programs and eligibility systems preferred Experience in a healthcare, hospital, or governmental environment preferred Associate's degree or higher in Business, Healthcare Administration, Social Services, or a related field preferred Strong computer proficiency, including the ability to navigate multiple applications and systems simultaneously and proficiency in Microsoft Office (Outlook, Excel, and Word) Excellent attention to detail and accuracy Strong analytical and problem-solving skills, with the ability to interpret policies, procedures, and eligibility guidelines Strong verbal and written communication skills and a customer service orientation Excellent organizational and time-management skills, with the ability to manage multiple priorities in a fast-paced environment Ability to work independently and as part of a team Ability to meet performance expectations for quality, productivity, and timeliness Demonstrated ability to maintain confidentiality and handle sensitive information This position is required to report on-site at the assigned facility and requires access to hospital systems and Missouri Medicaid eligibility systems Must comply with hospital-specific access, security, and training requirements as applicable Benefits: ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset!

We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families. Medical, Dental & Vision Insurance 401K (100% match for the first 3% & 50% match for the next 2%) 15 days of PTO 7 paid Holidays 2 Floating holidays 1 Elevate Day (floating holiday) Pet Insurance Employee referral bonus program Teamwork: We believe in teamwork and having fun together Career Growth: Gain great experience to promote to higher roles The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training.

This pay scale is not a promise of a particular wage. The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change. ElevatePFS is an Equal Opportunity Employer