Because nobody is prepared for a sudden hospital stay or other medical emergency, many Americans find themselves with medical and financial challenges they are unprepared to meet. As anyone who has experienced this will attest, it is stressful and scary when concerns about your or a loved one’s health are compounded by uncertainties about insurance coverage.
Patients need an advocate who can ensure that they have access to the right treatment and care. They need someone they can trust to secure the financial relief necessary for them to take care of their physical, mental and emotional health.
Meanwhile, healthcare providers face significant reimbursement challenges, ranging from the rise in uninsured patients to the complexity of various federal, state and local regulations. Hospitals, clinics and other facilities must be able to access every potential revenue source to help ensure their financial health and ability to care for their patients.
Success in Medicaid eligibility (ME) means taking care of both these groups, and ME representatives are at the forefront of those efforts.
Representative, Navigator, Hand-Holder
One of the key traits needed to succeed as an ME representative is empathy, the heartfelt ability to put yourself in someone else’s position and feel what that person is feeling. Along with other “soft” skills such as passion and compassion, it opens the door for honest and intelligent communication with a patient, and that communication is essential to unlocking the right healthcare coverage.
Empathy creates trust and paves the way for strong relationships. Patients are unlikely to share highly personal health, financial, employment and other information with someone if a rapport has not been established, even if it is in their own best interest to do so. In addition, time is of the essence: Once that patient has left the hospital, the likelihood of reimbursement drops considerably. So, as an ME representative, you must build instant trust, making the patient feel comfortable and cared for, in order to encourage an honest dialogue.
You are not only that patient’s authorized representative, but also their personal navigator and hand-holder. You have the technical and emotional know-how to see them through this stage of their healthcare journey—finding out what their needs are and seeing that those needs are met—and you’ll be there for the follow-up, maintaining contact with the patient and case management.
“Harder” skills come into play as well, of course. Successful ME representatives have the training and experience to recognize patterns and identify connections and opportunities. They know the value of asking “one more question” that can uncover the previously elusive solution, and they are stubborn enough to keep investigating until that answer is found.
When the answer is found, both the patient and the facility are taken care of. The patient has the financial relief needed to focus on his or her well-being, and the facility has the cash flow needed to continue its mission of providing the community with exceptional care.
The best team of Medicaid eligibility representatives is made up of the right people—those special people who not only can be trained in the right knowledge and skills, but also have the right heart for the job. Thoroughly trained and armed with ongoing education and support, such a team is ready to uncover win-win opportunities and make a difference, with a smile.