Medicaid Eligibility Quality Assurance Specialist

Responsibilities

• Perform quality assurance activities for Medicaid eligibility operations to ensure that work efforts satisfactorily meet customer requirements in a systematic, reliable fashion, effectively using systems to do so
• Perform analytical assessments of data and assist the management team in using the data for decision-making purposes
• Maintain prompt and accurate documentation outlining all steps of the QA program that have been taken in individual organized files. Complete the proper forms. Audit the assigned number of accounts per day following a set schedule. Forms will be completed and submitted within required timelines
• Work independently with various departments to ensure revenue is maximized
• Maintain reports that are indicative of process improvement within departments while promoting a positive presence in improving these processes
• Make recommendations based on assessments that improve production and quality
• Ability to multi-task to ensure day-to-day work is complete as well as assigned projects
• Coordinate QA findings with appropriate departments, internal or external, and ensure that necessary follow up is done to resolve any negative results
• Provide documented results and process improvement to Director for departments not meeting company/client standards
• Perform special projects or other activities as assigned. Establish and maintain constructive working relationships with coworkers, supervisors, managers and executives, as well as external clients and other external business contacts

Preferred

• preferably as both a hospital-based screener and an application processor

Benefits

• Work from home.
• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.
• Eligibility for benefits may vary by location.
• Glassdoor
• 3.2
• Provider of hospitals and healthcare services.
• Nashville, Tennessee, USA
• https://hcahealthcare.com/
• Public Company
• Total Funding
• $11.51B
• 2026-04-30
• Post Ipo Debt· $3B
• 2025-10-31
• Post Ipo Debt· $3.25B
• 2025-02-24
• Post Ipo Debt· $5.25B
• Leadership Team
• Gary Sekulski
• Chairman, President and CEO
• Nick Lane
• Regional Vice President Human Resources
• Recent News
• Morningstar.com
• Dow Jones Top Company Headlines at 7 PM ET: Boeing Turnaround Shows Progress but Commercial Unit Sputters | Visa ...

Qualifications

• Must have 3 years of Medicaid eligibility Advocate experience
• Minimum of 3 years' experience within Medicaid Eligibility
• Experience with standard suite of Microsoft office software products
• Intermediate to advanced proficiency with Excel and Word required
• Work from home roles require employees must have high speed internet 60 MB download and 10 MB upload
• Preferably as both a hospital-based screener and an application processor
• Minimum of 3 years’ experience within Medicaid Eligibility

Required skills

• Medicaid Application Processing, Medicaid Eligibility, Medicaid Screening

Experience

• 3+ years