PACE Eligibility Specialist

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

Benefits offered by this job

Medical/Dental/Vision plans

Vacation time

Holidays (9) including floating days

Sick/Personal time

Volunteer Time Off

403b Retirement plan

Health and Wellness events

Job summary

Neighborhood Healthcare seeks an Eligibility Specialist to help participants access Medi-Cal/Medicare coverage for PACE services. This onsite role involves applying for coverage, assessing options, and coordinating renewals with DHCS, County, and CMS requirements.

The position requires a high school diploma or GED, 1 year of healthcare or customer service experience, and relevant certifications. Bilingual English/Spanish preferred, with a comprehensive benefits package and growth opportunities.

Qualifications

• High school diploma or GED required.
• CA DHCS PACE and Medi-Cal certification must be obtained within 60 days of hire.
• 1 year healthcare or customer service experience required.
• Valid driver's license and active auto insurance required.
• Bilingual English/Spanish preferred.
• Current Basic Life Support (BLS) certification required on hire and maintained.
• CPR and First Aid certifications required for all staff.

Responsibilities

• Assist individuals in applying for and retaining Medi-Cal and/or Medicare coverage.
• Assess and discuss coverage options with enrollees for best eligibility solutions.
• Submit applications timely per DHCS, County, and CMS expectations.
• Complete enrollment and eligibility reporting accurately.
• Ensure prompt follow-ups on assigned eligibility cases.
• Coordinate with PACE Social Services to resolve eligibility issues.
• Monitor Medi-Cal renewal processes and changes to accounts.
• Educate staff and participants on eligibility processes and updates.
• Assist with staff orientations and training.
• Accompany participants to external agencies as needed.
• Comply with all policies and attend required meetings.

Skills

Verbal and written communication

Bilingual English/Spanish

Interpersonal skills

Microsoft Office

Organizational skills

Education

High school diploma/GED

CA DHCS PACE Medi-Cal certification within 60 days

Tools

Microsoft Office

Job description

About Us

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.

• 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

About Us

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


• Bilingual(English/Spanish) preferred


• 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

Benefits

• 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.