Medicaid & Medicare Eligibility Coordinator

About the role

Immanuel Pathways PACE® is seeking an Eligibility Coordinator to work at the Immanuel Home Office in Omaha, NE. In this role, you will help older adults maintain access to essential healthcare benefits by managing Medicaid renewals, Medicare enrollment processes, eligibility documentation, and participant financial responsibility programs. You'll serve as a trusted resource for participants while partnering with internal teams and state agencies to ensure uninterrupted coverage and exceptional service.

Responsibilities

• Eligibility Coordination
  • Ensure participants obtain and maintain required Medicare and Medicaid eligibility.
  • Monitor participant eligibility status through RTE, CMS reports, and State sites; identify issues affecting enrollment, coverage, payment, or continued participation.
  • Assist participants, caregivers, and authorized representatives with Medicaid applications, annual renewals, redeterminations, and required documentation.
  • Track pending eligibility actions, deadlines, verifications, and agency requests to promote timely completion and continuity of coverage.
  • Establish and maintain relationships with state Medicaid resources.
  • Maintain knowledge of current and emerging information regarding Immanuel Pathways, Federal and state regulations, and trends; disseminate and educate staff.
  • Assist in developing procedures and improving best practices regarding Medicaid eligibility.
  • Participate in monthly/quarterly meetings with State Administrating Agency and Immanuel Pathway Centers.
  • Manage discussions with participants and authorized representatives regarding Medicaid Eligibility, Miller Trust (Iowa Centers), and Estate Recovery.
  • Provide timely communication of Medicaid status changes to Immanuel Pathway Centers, Accounting, and Risk Adjustment Analyst.
• Share of Cost & Client Participation
  • Manage Share of Cost, Client Participation, premium, spenddown, or related participant financial responsibility requirements.
  • Communicate participant financial responsibility information clearly and respectfully to participants, caregivers, authorized representatives, and internal stakeholders.
  • Coordinate with Accounting, Executive Directors, and leadership regarding outstanding balances, changes in financial responsibility, and required follow-up.
  • Maintain documentation of communications, follow-up actions, balances, and resolution status.
• Medicare & Medicaid Processes
  • Complete monthly Medicare enrollment, disenrollment, and reconciliation processes according to established timelines.
  • Enroll/disenroll Medicare-covered participants through the CMS portal.
  • Ensure all participants maintain Medicare coverage during enrollment; resolve discrepancies with participants, Social Work, and/or CMS.
  • Manage the monthly enrollment validation and Medicare Entitlement processes.
  • Work with Eligibility & Enrollment Supervisor on any enrollment/disenrollment issues.
• Documentation & Reporting
  • Maintain complete, accurate, and audit-ready eligibility records, reports, correspondence, and participant files.
  • Enter eligibility information, status changes, and follow-up notes accurately into applicable organizational systems.
  • Prepare and maintain tracking tools, spreadsheets, and reports related to eligibility status, renewals, discrepancies, and financial responsibility requirements.
  • Escalate complex eligibility, payer, agency, or participant financial responsibility concerns to the appropriate leader.
• Compliance & Collaboration
  • Adhere to applicable CMS, state Medicaid, HIPAA, participant rights, enrollment, disenrollment, and organizational requirements.
  • Collaborate with Enrollment, Finance, Accounting, Operations, Executive Directors, clinical team members, and leadership to support timely and accurate eligibility outcomes.
  • Protect privacy and maintain confidentiality of participant, employee, referral, payer, and organizational information.
  • Identify opportunities to improve eligibility workflows, documentation accuracy, renewal timeliness, and participant experience.
  • Perform other duties and special projects as assigned.

Requirements

• Education: Bachelor’s Degree in Business, Accounting/Finance, Marketing, Social Work, or a related field is preferred. Equivalent combination of relevant experience may substitute for education requirement.
• Experience: Two (2) years of experience in assisting individuals with Medicaid, Medicare, governmental benefit programs, eligibility, financial counseling, billing collection, payer coordination, or other governmental programs. One (1) year of experience working with the frail or elderly population is required, or completion of job-specific training related to working with the elderly population must be completed within the first six months of hire.
• Other Requirements:
  • Agree to abide by the philosophy, practices, and protocols of the Immanuel Pathways (PACE) organization.
  • Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
  • Must have a valid driver’s license, proof of insurance, and reliable transportation for driving to Immanuel Pathway Center locations.
  • Speaking and interpreting different languages is desirable.

Benefits

• Health: Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA).
• Life Insurance: Employer-paid life insurance.
• Time Off: Paid Time Off accruing from day one, floating holidays, paid holidays, and 8 hours of Volunteer Time Off per year.
• Retirement: 401K with employer match.
• Wellness: Wellness Program and Employee Assistance Program.
• Growth and Development: Advancement opportunities, Education Assistance Program (up to $5,250 per year for education assistance paid up front).
• Additional benefits including recognition programs, competitive compensation, and intentional employee experience initiatives.

About Immanuel

At Immanuel, we believe that our success is built on the collective strength of our people. Here’s why you’ll thrive as part of our team:

• Meaningful work: Our mission impacts the lives of residents/participants, their families, and the community.
• Growth Opportunities: We invest in mentorship, training, and advancement.
• Inclusive Culture: We celebrate uniqueness and foster an environment where everyone feels valued.
• Work-Life Harmony: Achieve your best work while maintaining a healthy work-life balance.
• Total Rewards: Focus on feedback, recognition, competitive compensation, and a robust benefits package.
• Intentional Experience: From Day One Orientation to leadership training, we invest in your employee experience.