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 fashion
  • Assesses and discusses coverage options with potential enrollees and participants for the best solution to eligibility issues
  • Works with the potential enrollee or participant to submit applications in a timely manner in accordance with DHCS, County. and/or CMS expectations
  • Completes and submits enrollment and eligibility reporting in an accurate manner
  • Ensures prompt and proactive follow-ups on assigned eligibility cases
  • Works with PACE Social Services to remedy eligibility issues, as needed
  • Initiates 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 referrals
  • Conducts in-services to educate and inform staff, participants, and their families of eligibility processes and updates
  • Assists with orientations and training of new staff
  • Accompanies participants to external facilities to address eligibility issues, such as County Offices, Social Security Office, Bank, etc., as needed
  • Complies with all department, organization, and government policies and procedures
  • Attends meetings and training courses, as required
EDUCATION/EXPERIENCE
  • High school diploma or GED required
  • CA DHCS PACE and Medi-Cal Marketing certification required within 60 days of hire
  • One year healthcare or customer service experience required
  • Valid CA driver’s license and proof of auto insurance required
ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities)
  • Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
  • Excellent interpersonal skills with proven ability to cultivate and build positive relationships with internal departments and external stakeholders
  • Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
  • Knowledge of and/or experience with HMO, Medi-Cal/Medicaid, Medicare, senior care related sales, and marketing
  • Excellent Microsoft Office applications and computer skills
  • Ability to successfully manage multiple tasks simultaneously.
  • Excellent planning and organizational ability
  • Excellent writing and presentation skills
  • Ability to think strategically and apply analytical skills
  • Ability 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)

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