Medicare/Medi-Cal Eligibility Specialist for Senior Care

Innovative Integrated Health, Inc.; California; Presencial; USD 55.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

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

Descripción de la vacante

PACE by IIH in California is seeking an Eligibility Specialist to support accurate determination, verification, maintenance, and reinstatement of participant eligibility in the PACE program. You will coordinate Medicare/Medi-Cal eligibility, annual redeterminations, COB, and retroactive enrollments while ensuring compliance with CMS and DHCS regulations.

You will collaborate with Intake, Social Work, Claims, Pharmacy, and IDT to enable timely enrollment and seamless coverage for frail elderly

Formación

• Proficient in MS Office with strong Excel skills for tracking logs.
• Excellent written and verbal communication with participants and stakeholders.
• Knowledge of Medi-Cal and Medicare eligibility rules and COB/TrOOP requirements.
• Ability to work independently in a collaborative team environment.
• Commitment to participant-centered care and the PACE model of care.

Responsabilidades

• Monitor daily participant eligibility and enrollment status with CMS and DHCS data.
• Review 820/834 eligibility files and CMS DTRRs for accuracy.
• Coordinate Medi-Cal redetermination and assist with renewals for participants.
• Lead reinstatement and retroactive enrollment processes with CMS.
• Coordinate COB and other payer management to ensure proper billing and reimbursement.

Conocimientos

MS Office

Excel

Communication

Attention to detail

Medi-Cal/Medicare

Independent work

Patient-centered care

Educación

Associate's Degree

CPR/First Aid

Herramientas

Relay Health

ECRS

MARx

DHCS systems

Descripción del empleo

PACE by IIH in California is seeking an Eligibility Specialist to support accurate determination, verification, maintenance, and reinstatement of participant eligibility in the PACE program. You will coordinate Medicare/Medi-Cal eligibility, annual redeterminations, COB, and retroactive enrollments while ensuring compliance with CMS and DHCS regulations.

You will collaborate with Intake, Social Work, Claims, Pharmacy, and IDT to enable timely enrollment and seamless coverage for frail elderly