Eligibility & Financial Determination Special

InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), providing enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers.

Responsibilities

• Administration – 80%
  • Reviews applications from the Enrollment Representative Group and works closely with them to obtain necessary documentation for Medicaid approval.
  • Serves as the primary contact for enrollment representatives for ongoing training and best practices.
  • Maintains a tracking system for applications received and their status, provided to the Medicaid Controller.
  • Ensures compliance with all State Medicaid Rules and Regulations for applications submitted to County Agencies.
  • Stays current on updates to Federal and State rules and regulations pertaining to Medicaid, Straight Medicaid, LTC, Spousal Impoverishment and Trusts, Food Stamps, Old Age Pension (OAP), and other relevant programs.
  • Collaborates with Accounts Receivable and the Medicaid Controller/Analyst to track Medicaid issues monthly.
  • Tracks private pay clients and facilitates a smooth transition to Medicaid eligibility.
  • Ensures all IGCP Medicaid staff acquire and maintain necessary Medicaid knowledge in collaboration with the Medicaid Redetermination Manager and Medicaid Controller.
  • Addresses 10-day notices, denial notices, or any other adverse notices of action received on new applications.
• Participant Medicaid Enrollment – 20%
  • Troubleshoots difficult cases with Enrollment Representatives and Eligibility & Financial Determination Specialists.
  • Updates enrollment representatives on application statuses and assists with questions, concerns, or roadblocks.
  • Collaborates with County Human Services staff, Social Workers, Intake, and other IGCP staff on eligibility and classification issues.
  • Provides leadership and motivation to enrollment representatives to ensure positive morale and teamwork.

Requirements

• 3+ years of total related experience.
• 1+ year 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.

Qualifications

• Preferred: Bachelor’s Degree.

Benefits

• Medical, dental, and vision insurance.
• Short and long-term disability, life insurance, and AD&D.
• Supplemental life insurance.
• Flexible spending accounts.
• 401(k) savings plan with company match.
• Paid time off and company-paid holidays.

Pay

Posted Pay Range: $50,800 - $63,500