Under the supervision of the Eligibility Supervisor, the Eligibility Specialist will assist participants/potential participants in obtaining Medi-Cal and Medicare Coverage to access PACE services.
Essential Functions of the Job:
- Assists individuals in applying for and retaining Medi-Cal and/or Medicare coverage. Collection of required information in a concise and accurate fashion.
- Assesses and discusses coverage options with all potential enrollees and participants for the best possible solution to eligibility issues.
- In collaboration with the potential enrollee or participant, submits applications in a timely manner in accordance with DHCS, County and/or CMS expectations.
- Completes and submits all reporting in an accurate manner.
- Ensures prompt and proactive follow-up on all assigned eligibility cases. May be required to work with PACE Social Services to remedy any/all eligibility issues.
- Initiates and monitors health coverage redetermination/renewal process for patients. Completes Medi-Cal Renewal Package, Reports all changes on active accounts, Medi-Cal Add-Ons, Referrals.
- Conducts in-services to educate and inform staff, participants and their families of eligibility processes and updates.
- Assists in orientation and training of new staff.
- If needed, accompany participants to external facilities to address eligibility issues (County Offices, Social Security Office, Bank etc.)
- Complies with all department, organization, and government policies & procedures.
- Attends meetings and training courses as required.
- Performs other related duties as assigned or requested.
Experience Required:
- A minimum of 2 years of experience performing eligibility assistance, case management, referrals, or related functions. Related education may substitute for experience.
- A minimum of 1 year working with and/or assisting seniors.
- High School Diploma or GED equivalent required.
- Preferred: Bachelor’s degree in a health or human service field.
- CA driver’s license with appropriate automobile insurance required.
- Must complete the training for the State of California DHCS PACE and Medi-Cal Marketing Guidelines within 60 days of hire.
- Must have excellent oral and written communication skills.
- Bilingual (English/Spanish) is preferred but not required.
- Knowledge of local, state, and federal public health assistance programs and respective policies and regulations.
- Proficient in Microsoft applications and use of electronic health data systems including NextGen, CalWin, CalHEERS, TruChart.
- At a minimum, must have good computer/tablet literacy including internet navigation and research skills.
- Demonstrated ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service
- Self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines
- Provide prompt, efficient and responsive customer service.
- Computers, iPads/tablets, phones, personal vehicle, copy machines, fax machines, and other general office equipment.
- May be required to lift to 30 lbs., stand and walk frequently indoors and outdoors; set-up/take down outreach equipment.
- Will be required to travel to other sites or other locations within San Diego County.
- Will be required to work some evenings, weekends, or Holidays.
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
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