Medicare & Medi-Cal Eligibility Specialist

Paycom - ATS; Stockton (CA); On-site; USD 28,000 - 33,000; Full time

Benefits offered by this job

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

PACE by IIH in Stockton, CA is seeking an Entry-level Eligibility Specialist to support accurate determination, verification, maintenance, and reinstatement of participant eligibility for the PACE program. You will focus on Medicare and Medi-Cal eligibility, redetermination, COB, and retroactive enrollment while aligning with CMS and DHCS regulations.

Collaborating with Intake, Social Work, Claims, Pharmacy, and the IDT, you will ensure timely enrollment, compliance, and participant-centered

Qualifications

• MS Office proficiency with strong Excel skills.
• Two years of professional experience in managed care eligibility, enrollment, or COB coordination.
• Associate degree or higher in a related field is required.

Responsibilities

• Monitor participant eligibility and enrollment status per DHCS/CMS reports.
• Assist Medi-Cal redeterminations and renewals, including outreach and documentation.
• Coordinate COB and payer communications (CMS, PBM) for correct adjudication.
• Maintain enrollment/eligibility databases and tracking logs; support IDT communications.

Skills

MS Office

Excel

Education

Associate's Degree in Business Administration, Healthcare Administration, or related field

Tools

DHCS systems

CMS systems

ECRS

MARx

Relay Health

Job description

PACE by IIH in Stockton, CA is seeking an Entry-level Eligibility Specialist to support accurate determination, verification, maintenance, and reinstatement of participant eligibility for the PACE program. You will focus on Medicare and Medi-Cal eligibility, redetermination, COB, and retroactive enrollment while aligning with CMS and DHCS regulations.

Collaborating with Intake, Social Work, Claims, Pharmacy, and the IDT, you will ensure timely enrollment, compliance, and participant-centered