Eligibility Specialist
Who We Are
PACE by IIH is empowering senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support. Through an interdisciplinary and participant-centered model of care, PACE by IIH is committed to improving quality of life, promoting independence, and providing compassionate support tailored to the unique needs of each participant. Our team works collaboratively to deliver innovative, community-based healthcare solutions that allow seniors to remain safely and comfortably in their homes while receiving the care and services they need to thrive.
Benefits
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid sick time
- Paid time off
- Referral program
- Retirement plan
- Vision insurance
Job Summary
Under the supervision of the Eligibility Supervisor, the Eligibility Specialist is responsible for resolving accounts receivable pertaining to participants’ eligibility and enrollment issues. The Eligibility Specialist will ensure the goals and objectives of the Finance department are achieved while abiding to state and federal rules and regulations. This position is expected to be highly collaborative by working closely with other departments such as the Claims, Intake, and Social Work teams to remedy any eligibility/enrollment issues.
Essential Job Functions
Duties include, but are not limited to:
- Monitor participant eligibility/enrollment status as provided by state and federal agencies such as the Department of Health Care Services (DHCS) and the Center for Medicare and Medicaid Services (CMS)
- Track eligibility/enrollment changes daily for documentation purposes
- Track Medicare eligibility dates for all participants and work with Intake to ensure timely enrollment
- Assist with retrospective and prospective enrollment/disenrollment efforts
- Initiate and maintain proper follow-ups with DHCS and CMS to ensure timely processing and completion of all mandated applications and accompanying documentation Maintain knowledge of eligibility and enrollment requirements for individuals participating in the Program of All-inclusive Care for the Elderly (PACE), including but not limited to out-of-area issues, Share of Costs (SOC), Primary Aid Codes, and excluded benefits
- Update enrollment/eligibility databases and other tracking spreadsheets including but not limited to Medi-Cal/Medicare eligibility issues
- Assist all departments in confirming/verifying participant eligibility/enrollment status for internal and external inquiries for coordination of care
- Attend and participate in staff meetings, in-services, projects, and committees as assigned
- Adhere to and support the company practices, procedures, and policies including assigned break times and attendance
- Accept assigned duties in a cooperative manner and perform all other related duties as assigned.
- Be flexible in schedule of hours worked
- Accept assigned duties in a cooperative manner and perform all other related duties as assigned
- May require use of personal vehicle.