Eligibility & Financial Determination Lead

InnovAge Holding Corp.; Charlottesville (VA); On-site; USD 52,000 - 65,000; Full time

Job summary

InnovAge Holding Corp. seeks an Eligibility and Financial Determination Lead to work with Enrollment Representatives reviewing Medicaid applications for Innovage PACE applicants, ensuring timely review and exceptional service.

Responsibilities include staff training, application reviews, and maintaining tracking systems; ensuring Medicaid compliance across state rules, with collaboration across county agencies and internal teams.

Qualifications

• 4+ years total related experience required.
• 2+ years with CBMS Medicaid system and knowledge of Medicaid benefits.
• 2+ years working with the frail or elderly population.

Responsibilities

• Train new staff on the Specialists team and support the supervisor in their absence.
• Review applications from Enrollment Representatives and obtain necessary documentation for Medicaid approval.
• Maintain tracking of applications from submission to approval, including private pay transitions.
• Ensure compliance with State Medicaid rules and regulations; stay current on updates.
• Collaborate with Accounts Receivable and supervisor on case issues and training needs.
• Provide leadership to Eligibility Specialists to maintain morale and teamwork.
• Respond promptly to 10-day notices and denial notices on new applications.

Skills

4+ yrs total related experience

2+ yrs CBMS Medicaid

2+ yrs working with elderly

Education

Bachelor's degree

Job description

The Eligibility and Financial Determination Lead works in conjunction with the Enrollment Representatives in reviewing the Medicaid applications being submitted on behalf of Innovage PACE applicants to County Technicians. They are responsible for providing exceptional customer service to applicants and their representatives as well as timely review and tracking of applicants during the enrollment process.

Administration– 80%

• Train new staff on the Specialists team as well as provide support to the team in the absence of the supervisor.
• Reviews applications from Enrollment Representatives and works closely with them in obtaining necessary documentation needed for Medicaid approval. Works as the primary contact for the Eligibility Specialists for ongoing training and best practices.
• Ensures tracking system in place to track applications and the status of each application from first submission to approvals. To include private pay participants, transition to Medicaid as pay source.
• Ensures compliance with all State Medicaid Rules and Regulations with applications being submitted by Innovage to the County Agencies. Fulfilling this by keeping current on updates of Federal and State rules and regulations that pertain to Medicaid, Straight Medicaid, LTC, Spousal Impoverishment and Trusts, Food Stamps, Old Age Pension (OAP) and other Medicaid programs for which IGCP participants may be eligible.
• Works with Accounts Receivable and their supervisor with trouble shooting case issues.
• Ensures that all IGCP staff acquire and maintain the necessary Medicaid knowledge needed for the position. Assists with training and re training/guidance of staff as needed.
• Immediate attention to VCL (10-day notices) and denial notice or any other adverse notices of action received on new applications that were submitted to the county technicians.

Participant Medicaid Enrollment– 20%

• Troubleshoots difficult cases with Enrollment Representatives and Eligibility & Financial Determination Specialists
• Works extensively with the Eligibility Specialists and Enrollment Representatives to update them on the status of their applications and to assist with any questions, concerns, or roadblocks.
• Works with eligibility and classification issues in collaboration with the County Human Services staff, Social Workers, Intake and other IGCP staff.
• Demonstrates by example and leadership to provide motivation and direction to the Eligibility Specialists on an as needed basis to ensure positive moral and teamwork.

REQUIRED

• 4+ yrs total related experience
• 2+ yrs with CBMS Medicaid system and current knowledge of Medicaid systems and benefits
• 2+ yrs working with the frail or elderly

PREFERRED

• Bachelors degree

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

Applicants are considered until the position is filled.

$52,000-$65,000

Compensation Disclaimer

The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.

Attention Florida Applicants

This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.
For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com