Eligibility & Financial Determination Special

InnovAge Holding Corp.; Newport News (VA); On-site; USD 47,000 - 59,000; Full time

Job summary

InnovAge is seeking an Eligibility & Financial Determination Specialist to oversee Medicaid applications for IGCP participants, collaborating with Enrollment Representatives and County technicians to ensure accurate documentation and timely approvals.

This role focuses on compliance with Medicaid rules, tracking applications from submission to decision, aiding private-pay transitions, and maintaining Medicaid knowledge across staff.

Qualifications

• 3+ yrs total related experience.
• 1+ yr with CBMS Medicaid systems and knowledge of Medicaid system and benefits.
• High School diploma or GED.
• Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.

Responsibilities

• Reviews applications from Enrollment Representatives and coordinates documentation for Medicaid approval.
• Tracks status of each application from submission to approvals and informs stakeholders.
• Ensures compliance with State Medicaid Rules and Regulations for filings by InnovAge to county agencies.
• Maintains Medicaid knowledge in collaboration with the Medicaid Redetermination Manager and Medicaid Controller.

Education

High School diploma or GED

Bachelor's Degree

Job description

TheEligibility & Financial Determination Specialist works in conjunction with the Enrollment Representatives in overseeing the Medicaid applications being submitted on behalf of InnovAge PACE Participants to the County Technicians.

Administration – 80%

• Reviews applications from the Enrollment Representative Group and works closely with them in obtaining necessary documentation needed for Medicaid approval. Works as the primary contact for the enrollment representative for ongoing training and best practices.
• Tracking system in place and provided to the Medicaid Controller showing applications received and the status of each application from first submission to approvals.
• 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 the Medicaid Controller/Analyst to track on a monthly basis Medicaid issues with IGCP participants.
• Tracking private pay clients and instrumental in obtaining a smooth transition to Medicaid eligibility.
• Ensures that all IGCP Medicaid staff acquires and maintain the necessary Medicaid knowledge needed for the position in collaboration with the Medicaid Redetermination Manager and the Medicaid Controller.
• Immediate attention to 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 enrollment representatives to update them on the status of their applications and to assist with any questions, concerns or roadblocks.
• Deals 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 enrollment representatives on an as needed basis to ensure positive moral and teamwork.

REQUIRED

• 3+ yrs total related experience
• 1+ yr with CBMS Medicaid systems and knowledge of Medicaid system and benefits
• High School diploma or GED
• Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.

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.

$47,200 - $59,000

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