Medicaid Eligibility Navigator

Bethesda Group; Colorado Springs (CO); On-site; USD 46,000 - 53,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Wellness Program

Telemedicine

HSA

Job summary

Rocky Mountain Health Care’s (RMHCS) seeks an Eligibility Advocate to establish and maintain Medicaid eligibility for program participants. You will coordinate with DHS, the SEP, and case managers to ensure timely approvals and accurate documentation.

In this role you will track statuses, review CBMS data, and communicate with participants and partners. The position focuses on eligibility processing, documentation, and revenue protection with strong attention to detail.

Qualifications

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required.
• Thorough understanding of the DHS, Medicaid, VA, and Social Security programs and processes.
• Certified Medicaid Professional I (MCMP-I) highly desired.

Responsibilities

• Initiates Medicare, SNAP, and/or Long-Term Care Medicaid Waiver application process for potential participants, including submission and verification gathering.
• Tracks and follows-up on application status to ensure timely enrollment and census increases.
• Reviews CBMS and liaises with DHS to obtain eligibility status and maintain accurate trackers.
• Serves as the main contact for participants, families, and representatives on eligibility matters and resources.
• Documents encounters in the Electronic Health Record to retain auditable files.
• Requests and tracks records from doctors, banks, insurers, and other entities as needed.
• Assists with establishing income trusts and coordinating with health partners; calculates monthly deposits.
• Guides clients through Medicaid spenddowns and coordinates disability applications with ARG and DHS.
• Manages recertification caseload and CSR documentation to avoid coverage lapses.
• Supports finance in Medicaid payments validation and accounts receivable processes.

Skills

Technical Expertise

Problem Solving

Teamwork

Effective Communication

Results Oriented

Personal Credibility

Quality Focus

People Focus

Flexibility

Education

Associate’s degree or equivalent experience

Tools

CBMS

EHR

Job description

Rocky Mountain Health Care’s (RMHCS) seeks an Eligibility Advocate to establish and maintain Medicaid eligibility for program participants. You will coordinate with DHS, the SEP, and case managers to ensure timely approvals and accurate documentation.

In this role you will track statuses, review CBMS data, and communicate with participants and partners. The position focuses on eligibility processing, documentation, and revenue protection with strong attention to detail.