Eligibility & Financial Determination Specialist - PACE

Colorado PACE has an opening for an Eligibility & Financial Determination Specialist.

Location: Aurora, CO

Status: Full-time

Schedule: Monday-Friday, 8-5

Hourly Pay Range: $ $22.50

Supplemental Pay: Based on position, schedule and/or availability: Overtime

Mileage and Expense Reimbursement: Sixty-two and a half cents per mile – one of the highest in the industry

CULTURE, BENEFITS AND PERKS:

• We value engagement, community, and outreach initiatives and know it matters for our team members and our patients. We provide welcoming and supportive care to our patients and a work environment where all team members feel respected and valued.
• We support a culture of work-life balance and provide team members with two, free, confidential and robust benefit programs designed to provide solutions to the logistical and financial problems that arise in life.
• Low healthcare premiums: we have not increased our team member medical rates 4 out of the last 5 years
• Employer pays over 90% of employee medical premium in some plans
• Health Savings Account (HSA) with significant Employer Funding: Single $1,000, Family $2,000
• Healthcare Benefits are effective on the 1st of the month following date of hire
• Extensive Paid Time Off (PTO/Vacation Pay/Sick Leave) and EIB (Extended Illness Bank): 18 days in the first year for FT team members
• Seven Paid Holidays with an additional Floating Holiday
• 403(b) Retirement Plan with Employer Match: 50% match up to 8% of total compensation
• Company-Paid Life and AD&D Insurance
• Career & Logo wear
• Education Reimbursement Program
• Clinical Career Ladders
• Certification Pay
• Generous Discover-a-Star Team Member Referral Program
• Team Member Service Awards
• Early Wage Access
• Legal and Identity Protection
• Robust Leadership Development Training Programs

REWARDING WORK YOU WILL DO:

Administration & Compliance (80%)

• Reviews/prepares Medicaid applications and partners with the Enrollment Team and PACE Interdisciplinary Team (IDT) to obtain all required financial and personal documentation needed for timely eligibility decisions.
• Serves as the primary point of contact regarding Medicaid application processes, best practices, and ongoing training.
• Maintains a tracking system for all submitted applications from initial submission through approval, providing regular updates to the Director of Business Development, PACE Center Director(s) and PACE Executive Director.
• Ensures all applications comply with Colorado Medicaid rules and regulations, including updates to Health First Colorado, Long-Term Care (LTC) Medicaid, Spousal Impoverishment provisions, Trusts, Old Age Pension (OAP), and related Medicaid programs applicable to PACE participants.
• Collaborates with Accounts Receivable to monitor and resolve monthly Medicaid-related issues for PACE participants.
• Monitors private pay participants and supports seamless transitions to Medicaid eligibility when appropriate.
• Ensures all eligibility staff maintain current knowledge of Medicaid policies and application processes.
• Responds promptly to adverse action notices, including 10-day notices, denials, and requests for additional information from County Human Services.

Participant Eligibility Support (20%)

• Troubleshoots complex eligibility cases in partnership with Enrollment Team and IDT.
• Provides regular updates to Director of Business Development, PACE Center Director(s) and PACE Executive Director on application status, assisting with questions, barriers, and required follow-up.
• Collaborates with County Human Services, Social Workers, Intake, and PACE interdisciplinary teams to resolve eligibility, financial classification, and documentation issues.
• Demonstrates leadership by modeling professionalism, providing guidance, and supporting positive morale and teamwork within the Enrollment team.

WHAT WE ARE GOING TO LOVE ABOUT YOU:

• Minimum Education: High School Diploma or equivalent
• Minimum Experience: Prior experience working with the frail and elderly population in a healthcare setting. 2 years' experience in Medicaid eligibility, financial determination, or benefits coordination. 1 year experience working with CMS and strong knowledge of Colorado Medicaid Benefits.
• Required License: Valid Colorado Driver's License and proof of auto insurance.

PHYSICAL REQUIREMENTS:

• Ability to lift/carry a minimum of 30 lbs

Colorado PACE is affiliated with Care Synergy, a nonprofit network of community-based hospice and palliative care organizations serving Colorado's Front Range and the Region's Largest Home Health, Hospice, and Palliative Care Network. Care Synergy provides mission support services to better equip Colorado PACE to operate as a distinct and independent organization while working together to share best practices and serve more Coloradans along the Front Range.

If you need assistance completing the electronic application please contact our Talent Acquisition team via email at cs- You may also call the Human Resources Department at Applications can be completed in-person at any one of our affiliate office locations.

The Organization does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, gender identity, pregnancy, national origin, age, disability, creed, ancestry, genetic information, marital status, sexual orientation/identity, transgender status, military or veteran status, or any other characteristic protected by federal, state, or local law. This prohibition includes unlawful harassment based on any of these protected classifications.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.