Eligibility Specialist

2 months ago

Southfield, United States PACE Southeast Michigan Full time
ELIGIBILITY/BILLING SPECIALIST

Under the supervision of the Director of Operations and Enrollment, PACE Southeast Michigan (SEMI), the Eligibility Specialist is responsible for assisting with the paperwork for benefits such as Medicaid and Medicare. This includes new applications and redeterminations for Medicaid.

SPECIFIC DUTIES AND RESPONSIBILITIES:

  • Works with and assists PACE SEMI staff, specifically the Billing Specialist, for/with Medicaid application process, Medicaid recertification process, Medicare needs and Disenrollment Process.
  • Collects necessary information for program eligibility, including at the participant's home if necessary.
  • Documents and records all efforts and steps taken, including dates during the application or recertification process for each PACE SEMI candidate or enrollee.
  • Works with state agencies on all Medicaid issues affecting current PACE SEMI participants, including but not limited to recertification, over resource issues or food stamp issues.
  • Communicates professionally and appropriately with PACE SEMI staff members, participants or prospective participants, PACE SEMI Contractors and State Agency employees, at all times.
  • Keeps confidential, all PACE SEMI participant information, and/or all other information pertaining to PACE SEMI participants, issues or business practices.
  • Provide quality services to participants.
  • Ensures compliance to departmental and external standards in the provision of quality focused care by attendance at professional meetings/committees and review of national standards of practice.
  • Other duties as assigned.
  • Complete understanding of PACE SEMI PACE, including all aspects of qualifying new participants.
  • Provide assistance to Intake department through telephone screening, education, document preparation, provide tours of facilities, and coordination of potential participants.
KNOWLEDGE SKILLS AND ABILITIES:
  • College degree preferred.
  • Minimum of High School diploma with familiarity with government funded programs.
  • Knowledge of government benefits programs and other related social service programs.
  • At least 1 year experience in a Medicaid field is preferred.
  • Computer literate.
  • Demonstrated ability to follow-through on planned tasks or activities, involving tracking, documentation, distribution, facilitation and communication.
  • Established ability to make decisions independently, to influence others and resolve issues.
  • Ability to recognize the types of issues and/or when to escalate an issue to a more senior project team member.
  • Recognized ability to work both independently and as a member of a team.
  • Proven organization skills to multitask while maintaining attention to detail and meeting deadlines.
  • Effective communication skills both verbal and written.

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