Eligibility Services Representative

Colorado Access; Denver (CO); Hybrid; USD 52,000 - 56,000; Full time

Benefits offered by this job

PTO

Floating holidays

Nine company paid holidays

Hybrid work environment

Employee Assistance Program

401K

Job summary

Colorado Access in Denver is seeking an Eligibility Services Representative to join our mission-driven team. You will process Long Term Care applications, educate clients, and help determine eligibility with accuracy and privacy in a high-volume environment.

The role requires a high school diploma (associate degree preferred), CBMS experience, and strong client service skills. Bilingual (Spanish/English) is a plus, and a willingness to work in a hybrid office/remote setup.

Qualifications

• Education: High school diploma required; associate degree preferred.
• Experience in client service and determining medical eligibility within CBMS.
• One year of Long-Term care Medicaid Eligibility experience.
• Bilingual (Spanish/English) preferred.

Responsibilities

• Process LTC applications and educate clients on information needed for timely determinations.
• Provide superior client service and verify documentation for eligibility.
• Conduct interviews to verify information and detect fraudulent documents.
• Collaborate with state agencies and partners to initiate ULTC100 forms.
• Enter data in CBMS and process applications within required timeframes.
• Maintain privacy of Protected Health Information and quality standards.
• Assist customers with Connect for Health Colorado marketplace options.

Skills

Client service

Call center

Communication skills

Problem-solving

Attention to detail

Organizational skills

Multitasking

Education

High school diploma

Associate degree

Tools

CBMS

Job description

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.

1. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:

We are looking for a ELIGIBILITY SERVICES REPRESENTATIVE who can help shape our vision and support our mission. Here is what the position will look like.

• Serves as primary eligibility resource to process Long Term Care (LTC) applications for clients by educating clients on information needed for a timely determination and by gathering income documentation, financial documentation and other necessary supporting information. Provides assistance with the application process telephonically, via mail and in person.
• Provides superior client service to clients including but not limited to eligibility requirements for verifying documentation such as bank statements, trust documents and real estate records, etc. to determine eligibility accurately.
• Conducts thorough interviews with clients to verify accuracy of information and to determine and/or rule out fraudulent documentation. Determines periods of ineligibility (POI) if any resources have been given away by the client in the past five years.
• Per the State requirements, LTC processors will work in conjunction with the state disability contractor, the Action Review Group (ARG), to determine if the client meets the Social Security Administration definition of a disability when necessary.
• Works closely with Single Entry Point agencies to begin ULTC100 forms for functional eligibility determination for clients requesting Long Term Care services.
• UtilizesCBMS system to enter data and process all applications to determine eligibility while holding the highest regards to accuracy, quality, security and privacy of the CBMS system.
• Processes all applications including in person, mailed in or dropped off applications in the required time frames mandated by the State contract, this includes all aspects of case updates as reported by the client and ongoing case maintenance activities.
• Utilizes resource materials, policies and procedures, handouts, databases and training opportunities to ensure accuracy and quality of all aspects of application processing.
• Meets individual performance production requirements, quality and client service standards as assigned by the department management team.
• Attends all training and participates in internal and external performance audits to ensure compliance with quality standards.
• Assists clients in a professional, ethical manner following State guidelines to ensure the privacy of Protected Health Information.
• Works with Community Providers / Facilities regarding changes or status of individual client cases when necessary. Develop relationships with Community Providers / Facilities and educate them on program rules and regulations as needed.
• Answers incoming calls with a high level of professionalism by researching, resolving client inquiries, concerns and issues. Provides accurate information to assist clients and documents the interaction in our client management system.
• Provides client service availability Monday through Friday, 8:00am to 5:00pm except for office closure and/or scheduled department training.
• Assists customers and prospective customers with Connect for Health Colorado marketplace health plan options by providing accurate, objective information about available plans and enrollment resources.

What you will bring:

Education: High school diploma required. Associate’s degree in health, social services or additional college courses preferred.

Experience: client service experience and determining medical eligibility within CBMS. One year determining Long-Term care Medicaid Eligibility experience. Bilingual (Spanish/English) preferred.

Knowledge, Skills, and Abilities: Demonstrates professionalism with face-to-face interactions with clients. Ability to work within a call center environment and answer inquiries in a professional manner; client service excellence for internal and external clients required. Able to effectively communicate with diverse clients. Knowledge of local health and community agencies and providers preferred. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills, proven problem-solving skills and attention to detail and excellent organizational skills. Able to work independently in a high-volume environment Requires the ability to use the Colorado Benefits Management System (CBMS) to facilitate quality outcomes and or resolutions for the benefit of clients, providers and Colorado Access. May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: Training Certification from the Colorado Health Care & Economic Security, the Staff Development Center. This certification can be acquired before or after hiring and must be obtained within 90 days of employment. A valid driver's license and proof of current auto insurance will be required.

Together we will be an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $51,600.00 - $56,240.00 annually and is a non-exempt (hourly) position.

Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.