Eligibility Specialist

Innovative Integrated Health; Fresno (CA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Health insurance

Vision insurance

Paid time off

Job summary

Innovative Integrated Health, located in Fresno, California, seeks an Eligibility Specialist to monitor participant eligibility and facilitate enrollment processes. This role involves collaborating with various departments to resolve issues and maintain accurate records. Applicants should have a minimum of two years in managed care organizations or relevant experience, alongside an Associate’s Degree. The position offers competitive benefits such as health insurance and retirement plans.

Qualifications

• Minimum of two years in managed care organizations without an Associate’s Degree.
• Experience in the healthcare field is preferred.
• Must be medically cleared for communicable diseases.

Responsibilities

• Monitor participant eligibility/enrollment status from state and federal agencies.
• Assist with enrollment/disenrollment efforts.
• Update eligibility databases and manage documentation.

Skills

Proficient knowledge of Microsoft Office

Effective communication skills

Attention to detail and accuracy

Ability to work independently

Highly organized

Education

Associate’s Degree

Job description

Who We Are

To empower our senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support.

Benefits

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Job Summary

Under the supervision of the Eligibility Supervisor, the Eligibility Specialist is responsible for resolving accounts receivable pertaining to participants’ eligibility and enrollment issues. The Eligibility Specialist will ensure the goals and objectives of the Finance department are achieved while abiding to state and federal rules and regulations. This position is expected to be highly collaborative by working closely with other departments such as the Claims, Intake, and Social Work teams to remedy any eligibility/enrollment issues.

Essential Job Functions

• Monitor participant eligibility/enrollment status as provided by state and federal agencies such as the Department of Health Care Services (DHCS) and the Center for Medicare and Medicaid Services (CMS)
• Track eligibility/enrollment changes daily for documentation purposes
• Track Medicare eligibility dates for all participants and work with Intake to ensure timely enrollment
• Assist with retrospective and prospective enrollment/disenrollment efforts
• Initiate and maintain proper follow-ups with DHCS and CMS to ensure timely processing and completion of all mandated applications and accompanying documentation Maintain knowledge of eligibility and enrollment requirements for individuals participating in the Program of All-inclusive Care for the Elderly (PACE), including but not limited to out-of-area issues, Share of Costs (SOC), Primary Aid Codes, and excluded benefits
• Update enrollment/eligibility databases and other tracking spreadsheets including but not limited to Medi-Cal/Medicare eligibility issues
• Assist all departments in confirming/verifying participant eligibility/enrollment status for internal and external inquiries for coordination of care
• Attend and participate in staff meetings, in-services, projects, and committees as assigned
• Adhere to and support the company practices, procedures, and policies including assigned break times and attendance
• Accept assigned duties in a cooperative manner and perform all other related duties as assigned.
• Be flexible in schedule of hours worked
• May require use of personal vehicle.

Qualifications

Knowledge, Skills and Abilities

• Proficient knowledge of computer skills, including Microsoft Office (Word, PowerPoint, and Outlook)
• Knowledge of general office procedures, equipment, and filing systems
• Ability to communicate effectively, both orally and in writing
• Ability to quickly learn department policies, procedures, goals, and services
• Attention to detail and accuracy
• Ability to change priorities regularly
• Ability to think critically, take initiatives, and work independently with minimal supervision
• Highly organized and ability to retrieve information quickly

Working Conditions and Physical Demands

• Ability to access all areas of the center throughout the workday.
• Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds.
• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.

Experience

• Minimum of two (2) years of professional experience in managed care organizations, required without an Associate’s Degree
• Experience in the health care field, preferred.

Education and Certification

• Associate’s Degree, required without professional experience
• Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact

Core Values

• CARE is central to what we do, prioritizing the well-being, dignity, and independence of our senior participants.
• COMPASSION in every interaction, ensuring kindness, empathy, and understanding guide our care.
• CULTURE that reflects the diverse backgrounds of those we serve and fosters a workplace where every team member feels supported, valued, and empowered to grow.
• COMMUNITY that fosters connection, belonging, and support for participants and their families.
• COMMITMENT to quality improvement, innovation, and delivering healthier outcomes.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.