Eligibility Advocate

Bethesda Group; Colorado Springs (CO); Sur place; USD 46 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical

Dental

Vision

Wellness Program

Telemedicine

HSA

Résumé du poste

Rocky Mountain Health Care’s (RMHCS) seeks an Eligibility Advocate to establish and maintain Medicaid eligibility for program participants. You will coordinate with DHS, the SEP, and case managers to ensure timely approvals and accurate documentation.

In this role you will track statuses, review CBMS data, and communicate with participants and partners. The position focuses on eligibility processing, documentation, and revenue protection with strong attention to detail.

Qualifications

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required.
• Thorough understanding of the DHS, Medicaid, VA, and Social Security programs and processes.
• Certified Medicaid Professional I (MCMP-I) highly desired.

Responsabilités

• Initiates Medicare, SNAP, and/or Long-Term Care Medicaid Waiver application process for potential participants, including submission and verification gathering.
• Tracks and follows-up on application status to ensure timely enrollment and census increases.
• Reviews CBMS and liaises with DHS to obtain eligibility status and maintain accurate trackers.
• Serves as the main contact for participants, families, and representatives on eligibility matters and resources.
• Documents encounters in the Electronic Health Record to retain auditable files.
• Requests and tracks records from doctors, banks, insurers, and other entities as needed.
• Assists with establishing income trusts and coordinating with health partners; calculates monthly deposits.
• Guides clients through Medicaid spenddowns and coordinates disability applications with ARG and DHS.
• Manages recertification caseload and CSR documentation to avoid coverage lapses.
• Supports finance in Medicaid payments validation and accounts receivable processes.

Connaissances

Technical Expertise

Problem Solving

Teamwork

Effective Communication

Results Oriented

Personal Credibility

Quality Focus

People Focus

Flexibility

Formation

Associate’s degree or equivalent experience

Outils

CBMS

EHR

Description du poste

Job Details: Job Location: Colorado Springs Explorer Location - COLORADO SPRINGS, CO 80920, Position Type: Full Time, Salary Range: $22.10 - $25.42 Hourly

POSITION SUMMARY

The Eligibility Advocate is responsible for establishing and maintaining Medicaid eligibility for program participants by coordinating with all payor sources. This position is Rocky Mountain Health Care’s (RMHCS) liaison to the Department of Human Services (DHS) and the single-entry point (SEP) and coordinates with these departments to expedite and track eligibility requirements ensuring timely Medicaid approvals and revenue protection This includes all eligibility evaluations and ongoing documentation that maintains participant eligible for the program. A successful Eligibility Advocate is self-motivated, detail-oriented, extremely well organized and possesses in-depth knowledge of Medicaid/Medicare requirements and processes.

MISSION

Improving lives, Optimizing wellness, Promoting independence

COMPETENCIES

• Technical Expertise
• Problem Solving
• Teamwork
• Effective Communication
• Results Oriented
• Personal Credibility
• Quality Focus
• People Focus
• Flexibility

RESPONSIBILITIES AND DUTIES

ESSENTIAL JOB FUNCTIONS

• Autonomously initiates Medicare, SNAP, and/or Long-Term Care Medicaid Waiver application process for potential participants. This includes but is not limited to application completion, assistance with gathering and processing verification items, application submission, and coordination with SEP case managers to ensure functional eligibility.
• Consistently tracks and follows-up on application status to ensure timely enrollment, smooth transition of care, maintenance of tracking database, and increased company census.
• Regularly reviews Colorado Benefits Management System (CBMS) and contacts the Department of Human Services’ (DHS) office to obtain eligibility status on new and currently enrolled participants. Updates department specific trackers to maintain accurate records of all current and potential participants.
• Serves as the initial and regular point of contact with potential participants, current participants, and appropriate representatives for all items/areas related to eligibility as well as community resources.
• Provides consistent professional written and verbal communication with community partners, participants, and appropriate representatives. Documents these encounters in the Electronic Health Record to retain accurate auditable files.
• Requests and tracks requests for records and other required documentation from doctors’ offices, financial institutions, retirement and investment companies, insurance companies/burial policy issuers, property assessors, social security offices, veteran’s affairs, prior participant employers, and others.
• Assists participants and/or their appropriate representatives with establishing income trusts at a financial institution of their choice when appropriate and confirming validity directly with state partner, Health Care Policy and Finance (HCPF). Coordinates the joint appointment with financial institutions and calculates required monthly deposits.
• Independently and as appropriate guides clients and their representatives through Medicaid compliant spenddowns when requested to maintain eligibility.
• Coordinates appropriate disability applications through the Medicaid appointed Action Review Group (ARG). Tracks disability determination and regularly communicates results with participant, ARG, and DHS and leadership of Intake and Enrollment.
• Independently tracks on average 140-200 current participant’s recertification (RRR) annually to ensure there is no lapses in coverage year to year. This includes but is not limited to coordinating with the SEP to complete Continued Stay Review (CSR) packet, revalidating all required documentation and applications through DHS, and working all cases out of pending status for outstanding items and/or information.
• Supports RMHCS finance department in validation of Medicaid payments through monthly case management of outstanding accounts receivable cases. This includes working closely with DHS and HCPF to correct cases, validate finances, and/or guide participants through needed documents.
• Independently maintain and updates participant shared payments for Assisted Living Facilities (ALF) or Skilled Nursing Facilities (SNF). Uses participant’s recording income to calculate payment due to facility and individual’s personal needs allowance. Conducts semiannual liability project to validate data, reviews with current participants, obtains signatures, files in participant records, provides to claims, and sends to applicable facility.
• Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format.
• Maintains professional affiliations and any required certifications.
• Performs other duties as assigned.

Qualifications

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of the DHS, Medicaid, VA, and Social Security programs and processes
• Certified Medicaid Professional I (MCMP-I) highly desired
• Extensive knowledge of community resources available to older adults and their families
• Case Management experience highly desired
• Strong time management, organization, and attention to detail
• Ability to effectively and independently represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• Minimum of 1 year of experience working with the frail and/or elderly populations preferred
• Experience working with an Electronic Health Record preferred

Benefits

We strive to provide our employees with a comprehensive and affordable benefits package including Medical and Prescription Drug, Dental, Vision Care, Wellness Program, Telemedicine Program, Flexible Spending Accounts, Health Savings Account, Company Paid Basic Life and Accidental Death & Dismemberment, Company Paid Long-Term Disability, Voluntary Life Insurance, Voluntary Short-Term Disability, Accidental Injury Insurance, Critical Illness, Hospital Indemnity, 403(b) Savings Plan, Legal Shield and IDShield, Employee Assistance Program (EAP), Paid Time-Off plan. Such benefits are based on applicable state law and factors such as pay classification (full-time, part-time, or PRN/casual), job grade and length of service.