PACE Eligibility Specialist

Ultipro; Murrieta (CA); On-site; USD 37,000 - 52,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

Vacation time

Paid holidays

Sick/personal time

403b Retirement plan

Wellness events

Job summary

Neighborhood Healthcare in Murrieta, CA is seeking an Eligibility Specialist to help participants obtain Medi-Cal and Medicare coverage for PACE services. Schedule: M-F, 8am-5pm; onsite role.

You will assess options, submit applications, and follow up on eligibility with PACE staff while upholding HIPAA and quality service. Strong communication and organizational skills are essential for success.

Qualifications

• High school diploma or GED required.
• BLS certification must be current at hire.
• CPR and First Aid certification required; renewal annually.
• CA DHCS PACE/Medi-Cal certification within 60 days of hire.
• 1 year healthcare or customer service experience required.
• Valid driver's license and active auto insurance.

Responsibilities

• Assist with Medi-Cal and Medicare applications for PACE enrollment.
• Educate participants about coverage options and renewal processes.
• Submit enrollment and eligibility paperwork accurately and on time.
• Follow up promptly on eligibility cases and coordinate with PACE staff.
• Attend required trainings and maintain HIPAA compliance.

Skills

Verbal communication

Written communication

Interpersonal skills

Organization

Ability to multitask

Analytical thinking

Teamwork

Education

High school diploma/GED

CA DHCS PACE/Medi-Cal Certification

1 year healthcare or customer service experience

BLS certification

CPR and First Aid certification

Valid driver's license and auto insurance

Tools

Microsoft Office

Job description

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

ROLE OVERVIEW and PURPOSE

The Eligibility Specialist will assist participants and potential participants in obtaining Medi-Cal and Medicare Coverage to access PACE services. Schedule: M-F, 8am-5pm. This position is onsite.

Responsibilities

• Assists individuals in applying for and retaining Medi-Cal and/or Medicare coverage, including collecting required information in a concise and accurate fashion
• Assesses and discusses coverage options with potential enrollees and participants for the best solution to eligibility issues
• Works with the potential enrollee or participant to submit applications in a timely manner in accordance with DHCS, County. and/or CMS expectations
• Completes and submits enrollment and eligibility reporting in an accurate manner
• Ensures prompt and proactive follow-ups on assigned eligibility cases
• Works with PACE Social Services to remedy eligibility issues, as needed
• Initiates and monitors health coverage redetermination/renewal processes for participants, including completing Medi-Cal renewal packages, reporting changes on active accounts, Medi-Cal add-ons, and referrals
• Conducts in-services to educate and inform staff, participants, and their families of eligibility processes and updates
• Assists with orientations and training of new staff
• Accompanies participants to external facilities to address eligibility issues, such as County Offices, Social Security Office, Bank, etc., as needed
• Complies with all department, organization, and government policies and procedures
• Attends meetings and training courses, as required

Qualifications

Education/Experience

• High school diploma/GED required
• CA DHCS PACE and Medi-Cal Marketing certification required within 60 days of hire
• 1 year healthcare or customer service experience required
• Valid driver's license required and maintained as a condition of employment
• Active auto insurance required and maintained as a condition of employment
• Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines- may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards.
  • In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually

Additional Qualifications (Knowledge, Skills and Abilities)

• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Excellent interpersonal skills with proven ability to cultivate and build positive relationships with internal departments and external stakeholders
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledge of and/or experience with HMO, Medi-Cal/Medicaid, Medicare, senior care related sales, and marketing
• Excellent Microsoft Office applications and computer skills
• Ability to successfully manage multiple tasks simultaneously.
• Excellent planning and organizational ability
• Excellent writing and presentation skills
• Ability to think strategically and apply analytical skills
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements

• Ability to lift/carry 10 lbs/weight
• Ability to stand for long periods of time

COMPLIANCE (Safety & HIPAA)

• Follows all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintains current knowledge of policies and procedures as they relate to safe work practices
• Follows all safety procedures and report unsafe conditions
• Uses appropriate body mechanics to ensure an injury free environment
• Familiarity with location of nearest fire extinguisher and emergency exits
• Follows all infection control procedures including blood-borne pathogen protocols
• Maintains privacy of all patients, employee and volunteer information and access such information only on a need-to-know basis for business purposes
• Complies with all regulations regarding corporate integrity and security obligations
• Reports all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!

Pay range: $27.21 - $38.09 per hour, depending on experience.

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.

Qualifications

Licenses & Certifications

Required

Basic Life Support

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.