Eligibility Specialist I

2 months ago

Cleveland, United States McGregor PACE Full time
Job DescriptionJob Description

McGregor PACE

Responsible for facilitating Medicaid renewals for all McGregor PACE participants. Responsible for maintaining an accurate census for McGregor PACE. Maintain active/inactive participant status in Truchart and all other software systems assigned. Perform collections for private/share of cost accounts.

ESSENTIAL DUTIES

  • Initiates and conducts appointments with current participants and applicants; to obtain all necessary authorizations and pertinent paperwork for submission to Special Medicaid Benefits Center (SMBC for Medicaid eligibility renewal. Responds to participant questions regarding Medicaid status and benefits.
  • Acts as Medicaid Authorized Representative for all McGregor participants
  • Expeditiously follows up on all aspects of application/renewal process with SMBC and other organizations for applicants and current participants as needed to obtain needed verifications to determination eligibility for Medicaid and Medicare benefits.
  • Consistent communication with Eligibility Manager and staff regarding delays that will affect applicants and current participant’s ongoing program eligibility.
  • Documents and records all activities during the Medicaid application and renewal process.
  • Serves as a resource to participants/residence, families and PACE staff for Medicaid eligibility.
  • Responsible for McGregor PACE AR aging, makes collection calls, and institutes payment plans after past due letters have been mailed. Documents all collection activity in Truchart.
  • Responsible for preparation of CMS reporting and communication requirements.
  • Responsible for maintaining Truchart enrollments/disenrollments as active/inactive within appropriate modules and all other software systems assigned.
  • Send out temporary and permanent PACE medical cards.
  • Other duties as assigned.

QUALIFICATIONS

  • One-year experience in home or community-based Medicaid waiver programs and health/social services program preferred
  • At least one year of experience working with older adults, especially dementia, preferred.
  • Up to date working knowledge and some experience in Ohio Medicaid and Federal Medicare regulations/systems preferred.
  • Current Ohio driver’s license and reliable car required
  • Basic proficiency in Windows and Word, Excel and Power Point preferred. Public speaking and presentation skills; strong communication skills preferred.
  • Bachelor’s degree preferred

Must have reliable transportation and a valid Ohio driver’s license.

EOE Pre-hire background check, and physical required.

Great pay Great benefits Ready to Hire

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