Outpatient Medicaid Eligibility Representative

The Revenue Group, a Cleveland-based leader in accounts receivable management for healthcare clients, is seeking an Outpatient Medicaid Eligibility Representative. In this role, you will review and verify Medicaid eligibility for outpatient accounts, gather and update patient demographic and financial information, and work with patients, providers, and payers to secure accurate coverage. You will document all activity in our systems, meet production and quality targets, and adhere to strict compliance, HIPAA, and Medicaid regulations. This is a professional, team-focused, and performance-driven environment with structured training, clear expectations, and opportunities to develop advanced revenue cycle and collections skills while supporting hospital and clinic clients in improving cash flow and patient experience.

Responsibilities

• Verify and process outpatient Medicaid eligibility for patients using state and federal systems

• Gather, review, and update patient demographic and financial information

• Communicate with patients, healthcare staff, and payers to obtain required documentation

• Explain Medicaid coverage requirements and next steps to patients professionally and clearly

• Document all eligibility activities and outcomes in billing and account systems accurately

• Meet or exceed productivity, quality, and compliance standards in a metrics-driven environment

• Collaborate with team members and supervisors to resolve complex eligibility issues

• Maintain strict confidentiality and follow HIPAA, Medicaid, and company compliance policies

• Identify and escalate trends or issues affecting eligibility and reimbursement

• Participate in ongoing training to stay current on Medicaid rules and internal procedures Required Skills

• Medicaid eligibility verification

• Healthcare revenue cycle knowledge

• Medical billing systems (EHR/EMR) use

• Data entry and accuracy

• Customer service and patient communication

• Insurance verification and authorization

• Compliance and HIPAA understanding

• Microsoft Office (Excel, Outlook, Word)

• Problem-solving and account research

• Call handling and phone etiquette