Medicare/Medi-Cal Eligibility Specialist for PACE

Innovative Integrated Health Inc; Fresno (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

Innovative Integrated Health Inc. in Fresno, CA seeks an Eligibility Specialist to support accurate determination, verification, and maintenance of participant eligibility for the PACE program.

You will coordinate Medicare and Medi-Cal eligibility, Medi-Cal redetermination, and COB processes while ensuring compliance and timely enrollment with the IDT. Collaborating with Intake, Social Work, Claims, and Pharmacy teams, you will help manage annual redetermination, COB screenings, and retroactive

Qualifications

• Proficient in MS Office with strong Excel for tracking and reporting.
• Good written and verbal communication; detail oriented.
• Experience in managed care or eligibility processes is preferred.

Responsibilities

• Monitor daily participant eligibility and enrollment status with DHCS/CMS.
• Assist Medi-Cal redeterminations, document consent, and gather verifications.
• Coordinate reinstatement and retroactive enrollment requests within policy timelines.
• Coordinate COB activities with PBM and CMS contractors; reconcile CMS files.
• Support enrollment and eligibility databases; collaborate with Intake, Social Work, Claims, and Pharmacy teams.
• Maintain compliance with CMS and DHCS regulations and HIPAA requirements.

Skills

MS Office

Excel skills

Attention to detail

Team collaboration

Education

Associate's Degree in Business/Healthcare Administration

Tools

Relay Health

MARx

ECRS

Job description

Innovative Integrated Health Inc. in Fresno, CA seeks an Eligibility Specialist to support accurate determination, verification, and maintenance of participant eligibility for the PACE program.

You will coordinate Medicare and Medi-Cal eligibility, Medi-Cal redetermination, and COB processes while ensuring compliance and timely enrollment with the IDT. Collaborating with Intake, Social Work, Claims, and Pharmacy teams, you will help manage annual redetermination, COB screenings, and retroactive