PACE Eligibility Specialist

2 weeks ago

Riverside, United States Neighborhood Healthcare Full time

About Us

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision: a community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 414,000 medical, dental, and behavioral health visits from more than 95,000 people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

Since 1969, our employees have been making this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If this sounds like an organization you would like to be a part of, we would love to meet you.

ROLE OVERVIEW and PURPOSE

The Eligibility Specialist will assist participants and potential participants in obtaining Medi-Cal and Medicare Coverage to access PACE services.

RESPONSIBILITIES

Assists individuals in applying for and retaining Medi-Cal and/or Medicare coverage, including collecting required information in a concise and accurate fashionAssesses and discusses coverage options with potential enrollees and participants for the best solution to eligibility issuesWorks with the potential enrollee or participant to submit applications in a timely manner in accordance with DHCS, County. and/or CMS expectationsCompletes and submits enrollment and eligibility reporting in an accurate mannerEnsures prompt and proactive follow-ups on assigned eligibility casesWorks with PACE Social Services to remedy eligibility issues, as neededInitiates and monitors health coverage redetermination/renewal processes for participants, including completing Medi-Cal renewal packages, reporting changes on active accounts, Medi-Cal add-ons, and referralsConducts in-services to educate and inform staff, participants, and their families of eligibility processes and updatesAssists with orientations and training of new staffAccompanies participants to external facilities to address eligibility issues, such as County Offices, Social Security Office, Bank, etc., as neededComplies with all department, organization, and government policies and proceduresAttends meetings and training courses, as requiredEDUCATION/EXPERIENCE

High school diploma or GED requiredCA DHCS PACE and Medi-Cal Marketing certification required within 60 days of hireOne year healthcare or customer service experience requiredValid CA driver’s license and proof of auto insurance requiredADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities)

Excellent verbal and written communication skills, including superior composition, typing, and proofreading skillsExcellent interpersonal skills with proven ability to cultivate and build positive relationships with internal departments and external stakeholdersAbility to interpret a variety of instructions in written, oral, diagram, or schedule formKnowledge of and/or experience with HMO, Medi-Cal/Medicaid, Medicare, senior care related sales, and marketingExcellent Microsoft Office applications and computer skillsAbility to successfully manage multiple tasks simultaneously.Excellent planning and organizational abilityExcellent writing and presentation skillsAbility to think strategically and apply analytical skillsAbility to work as part of a team as well as independently

Neighborhood Healthcare offers a generous benefit plan that includes: Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more

Pay Range:

$24.62 - $29.04 per hour, depending on experience (DOE) #J-18808-Ljbffr

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