Senior Care Eligibility Coordinator

Innovative Integrated Health, Inc.; Stockton (CA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Employee assistance program

Flexible spending account

Health insurance

Health savings account

Life insurance

Paid time off

Referral program

Vision insurance

Job summary

PACE by IIH seeks an Eligibility Specialist to support accurate eligibility determinations, verification, maintenance, and reinstatement for the PACE program. You will coordinate Medicare and Medi-Cal eligibility, annual redeterminations, COB, and retroactive enrollments while ensuring compliance and timely enrollment with the IDT and other departments.

You will collaborate with Intake, Social Work, Claims, Pharmacy, and clinical teams to resolve eligibility issues and support frail elderly

Qualifications

• Proficient in MS Office with strong Excel skills for tracking logs and reporting.
• Knowledge of Medi-Cal and Medicare eligibility rules, aid codes, and COB/TrOOP requirements.
• Associate's Degree or 2 years of managed care/eligibility experience required.

Responsibilities

• Monitor and verify participant eligibility and enrollment in the PACE program.
• Assist Medi-Cal redeterminations and renewals; manage outreach and document consent.
• Coordinate reinstatement, retroactive enrollment, and COB processes with CMS/DHCS.
• Maintain enrollment/eligibility databases and support cross-department teams.
• Adhere to CMS/DHCS regulations and HIPAA/privacy requirements.

Skills

MS Office

Excel

Communication skills

Attention to detail

Independent work

Education

Associate's Degree in Business Administration or Healthcare Administration

Tools

DHCS 834 files

CMS DTTRs

Relay Health

Job description

PACE by IIH seeks an Eligibility Specialist to support accurate eligibility determinations, verification, maintenance, and reinstatement for the PACE program. You will coordinate Medicare and Medi-Cal eligibility, annual redeterminations, COB, and retroactive enrollments while ensuring compliance and timely enrollment with the IDT and other departments.

You will collaborate with Intake, Social Work, Claims, Pharmacy, and clinical teams to resolve eligibility issues and support frail elderly