Medi-Cal Eligibility Resolution Specialist - Inland Empire

Qualifications

• Strong knowledge of Medi-Cal eligibility and public benefit programs
• Knowledge of Medi-Cal eligibility rules and redetermination processes
• Experience in working with electronic healthcare systems, and state eligibility systems
• Familiar with Microsoft Word and Excel programs
• Strong analytical, organizational and communication skills
• Strong communication skills
• Experience in a health plan, county eligibility office or healthcare revenue cycle
• Bilingual in Spanish preferred
• Experience resolving insurance denials or appeals
• PREFERABLY, has a bachelor’s degree in healthcare, business administration or related field

Essential Duties And Responsibilities

• Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows
• Conduct eligibility verification using state systems, EMR platforms, and insurance databases
• Communicate with county eligibility workers to clarify case status and resolve pending or denied actions
• Oversee and coordinate Medi-Cal redetermination submissions
• Track redetermination cycles and proactively engage members
• Contact members to gather required information and explain eligibility requirements
• Build relationships with county Medi-Cal offices
• Collaborate with internal departments including Member Services, Revenue Cycle, Clinical Teams, and Compliance
• Maintain accurate, audit-ready documentation
• Conduct in-person visits to county offices when necessary
• Track and report eligibility trends and case outcomes
• Driving will be required to county offices
• Maintain confidentiality, HIPAA compliance, and knowledge of mandated reporting requirements
• Uphold agency standards, policies, and procedures as outlined in the Employee Handbook
• Participate in departmental meetings and trainings as required
• Performs other duties as assigned

Physical Requirements

• Stand, sit, talk, hear, and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis up to 40% of the time
• Reach, stoop, kneel and bend up to 20% of the time
• Moderate amount of walking up to 15% of the time
• Moderate amount of driving up to 25% of the time
• Close vision requirements due to computer work on a frequent basis
• Light to moderate lifting may be required up to 25lbs on a frequent basis
• Pushing and pulling up to 25lbs