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Eligibility and Financial Determination Specialist
2 months ago
The Eligibility and Financial Determination Specialist plays a crucial role in overseeing the Medicaid application process for InnovAge PACE participants. This position works closely with Enrollment Representatives to ensure timely and accurate submissions to County Technicians.
Key Responsibilities- Review and process Medicaid applications from Enrollment Representatives, ensuring all necessary documentation is obtained for approval.
- Collaborate with Enrollment Representatives to provide ongoing training and best practices, promoting a high level of expertise in Medicaid application processing.
- Utilize a tracking system to monitor application status from submission to approval, providing regular updates to the Medicaid Controller.
- Ensure compliance with State Medicaid Rules and Regulations, staying up-to-date on federal and state updates that impact Medicaid, Straight Medicaid, LTC, Spousal Impoverishment, and other relevant programs.
- Work with Accounts Receivable and the Medicaid Controller/Analyst to identify and resolve Medicaid issues with IGCP participants on a monthly basis.
- Track private pay clients and facilitate a smooth transition to Medicaid eligibility.
- Develop and maintain a comprehensive knowledge base on Medicaid requirements, collaborating with the Medicaid Redetermination Manager and the Medicaid Controller.
- Respond promptly to 10-day notices, denial notices, and other adverse actions received on new applications submitted to County Technicians.
- Troubleshoot complex cases with Enrollment Representatives and Eligibility and Financial Determination Specialists.
- Provide regular updates to Enrollment Representatives on application status and assist with questions, concerns, or roadblocks.
- Collaborate with County Human Services staff, Social Workers, Intake, and other IGCP staff to resolve eligibility and classification issues.
- Lead by example and provide motivation and direction to Enrollment Representatives to ensure positive morale and teamwork.
- 3+ years of related experience.
- 1+ year of experience with CBMS Medicaid systems and knowledge of Medicaid benefits.
- High School diploma or GED.
- Valid state-issued driver's license, personal transportation, good driving record, and auto insurance as required by law.
- Bachelor's Degree.
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. Our Program of All-inclusive Care for the Elderly (PACE) provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. Our team members are our greatest asset and have a significant impact on the lives of our participants every day.
