PACE Eligibility Specialist

Posted yesterday

neighborhood healthcareMurrieta (CA)

Patient Representatives Services for the Elderly and Persons with Disabilities

SENIORITY

Senior

SALARY

$27.21 - $38.09 per hour

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About the role

Eligibility Specialist 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. Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community. As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants. Role Overview and Purpose The Eligibility Specialist will assist participants and potential participants in obtaining Medi-Cal and Medicare Coverage to access PACE services.

Schedule: M-F, 8am-5pm. This position is onsite.

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

QualificationsEducation/Experience High school diploma/GED requiredCA DHCS PACE and Medi-Cal Marketing certification required within 60 days of hire 1 year healthcare or customer service experience required Valid driver's license required and maintained as a condition of employment Active auto insurance required and maintained as a condition of employment Bilingual(English/Spanish) preferred Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines- may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards. In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually

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 skillsAbility to successfully manage multiple tasks simultaneously. Excellent planning and organizational ability Excellent writing and presentation skillsAbility to think strategically and apply analytical skillsAbility to work as part of a team as well as independently Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements:

Ability to lift/carry 10 lbs/weight
Ability to stand for long periods of time
Compliance (Safety & HIPAA)
Follows all safety procedures as outlined in Neighborhood Healthcare's Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
Maintains current knowledge of policies and procedures as they relate to safe work practices
Follows all safety procedures and report unsafe conditions
Uses appropriate body mechanics to ensure an injury free environment
Familiarity with location of nearest fire extinguisher and emergency exits
Follows all infection control procedures including blood-borne pathogen protocols
Maintains privacy of all patients, employee and volunteer information and access such information only on a need-to-know basis for business purposes
Complies with all regulations regarding corporate integrity and security obligations
Reports all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid 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: $27.21 - $38.09 per hour, depending on experience. Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate's overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.

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