Eligibility Coordinator - Senior Care (Hybrid)

Fresno PACE; Fresno (CA); Híbrido; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401(k)

Dental insurance

Health insurance

Paid time off

Vision insurance

Life insurance

Flexible spending account

Paid sick time

Retirement plan

Employee assistance program

Descripción de la vacante

Fresno PACE is seeking an Eligibility Specialist in Fresno, CA. Under the supervision of the Eligibility Manager, you will support accurate determination, verification, and reinstatement of participant eligibility for the PACE program, coordinating Medicare and Medi-Cal eligibility, redetermination, and COB.

You will collaborate with Intake, Social Work, Claims, Pharmacy and IDT to ensure timely enrollment, address eligibility issues, and maintain precise tracking in Excel.

Formación

• Associate degree in business/healthcare or 2+ years in managed care eligibility.
• Experience with Medicare/Medi-Cal eligibility preferred.
• Knowledge of CMS/DHCS processes is a plus.

Responsabilidades

• Monitor daily participant eligibility and enrollment status.
• Assist Medi-Cal redetermination including 120 days lead time.
• Coordinate COB and retroactive enrollment processes.
• Maintain enrollment/eligibility databases and reports.

Conocimientos

MS Office Proficiency

Excel Skills

Communication Skills

Detail Orientation

Educación

Associate Degree

Herramientas

DHCS Systems

CMS DTTRs

Descripción del empleo

Fresno PACE is seeking an Eligibility Specialist in Fresno, CA. Under the supervision of the Eligibility Manager, you will support accurate determination, verification, and reinstatement of participant eligibility for the PACE program, coordinating Medicare and Medi-Cal eligibility, redetermination, and COB.

You will collaborate with Intake, Social Work, Claims, Pharmacy and IDT to ensure timely enrollment, address eligibility issues, and maintain precise tracking in Excel.