Medicaid & Medicare Eligibility Coordinator

Immanuel•Omaha, NE

2d•Onsite

About The Position

In this role, you will help older adults maintain access to essential healthcare benefits by managing Medicaid renewals, Medicare enrollment processes, eligibility documentation, and participant financial responsibility programs. You'll serve as a trusted resource for participants while partnering with internal teams and state agencies to ensure uninterrupted coverage and exceptional service. The purpose of this job is to ensure PACE participants obtain, maintain, and appropriately document Medicare and Medicaid eligibility. The Eligibility Coordinator assists participants, caregivers, authorized representatives, internal teams, and external agencies by supporting Medicaid applications and renewals, completing Medicare enrollment and disenrollment processes, resolving eligibility discrepancies, tracking payer status, and coordinating Share of Cost or Client Participation requirements in accordance with regulatory, organizational, and program requirements.

Requirements

Two (2) years of experience in assisting individuals with Medicaid, Medicare, governmental benefit programs, eligibility, financial counseling, billing collection, payer coordination or other governmental programs is required.
One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.
Agree to abide by the philosophy, practices, and protocols of the Immanuel Pathways (PACE) organization.
Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
Must have a valid driver’s license, proof of insurance and have means of reliable transportation for driving to Immanuel Pathway Center locations.

Nice To Haves

Speaking and interpreting different languages is desirable.

Responsibilities

Ensure participants obtain and maintain required Medicare and Medicaid eligibility.
Monitor participant eligibility status through RTE, CMS reports received regularly, and State sites and identify issues that may affect enrollment, coverage, payment, or continued participant.
Assist participants, caregivers, and authorized representatives with Medicaid applications, annual renewals, redeterminations, and required documentation.
Track pending eligibility actions, deadlines, verifications, and agency requests to promote timely completion and continuity of coverage.
Establishes and maintains relationships with state Medicaid resources.
Maintain knowledge of current and emerging information regarding Immanuel Pathways, Federal and state regulations, and trends and disseminate and educate Immanuel Pathways managers and staff.
Assists in developing procedures and defining and improving best practices regarding Medicaid eligibility for Immanuel Pathway Center participants.
Participates in monthly/quarterly meetings with State Administrating Agency and Immanuel Pathway Centers, or as needed.
Manages all discussions with, and assists participant and authorized representative regarding Medicaid Eligibility, Miller Trust (Iowa Centers), Estate Recovery.
Provides timely communication of Medicaid status change to Immanuel Pathway Centers, Accounting, and Risk Adjustment Analyst.
Manage Share of Cost, Client Participation, premium, spenddown, or related participant financial responsibility requirements as applicable.
Communicate participant financial responsibility information clearly and respectfully to participants, caregivers, authorized representatives, and internal stakeholders.
Coordinate with Accounting, Executive Directors, and leadership regarding outstanding balances, changes in financial responsibility, and required follow-up.
Maintain documentation of communications, follow-up actions, balances, and resolution status.
Complete monthly Medicare enrollment, disenrollment, and reconciliation processes according to established timelines.
Enroll/disenroll Medicare covered participants through the CMS portal
Ensure all participants maintain Medicare coverage during enrollment and if there is a discrepancy, work with participant, Social Work, and/or CMS for resolution
Manages the monthly enrollment validation process
Manages the monthly Medicare Entitlement process
Works with Eligibility & Enrollment Supervisor on any enrollment/disenrollment issues.
Maintain complete, accurate, and audit-ready eligibility records, reports, correspondence, and participant files.
Enter eligibility information, status changes, and follow-up notes accurately into applicable organizational systems.
Prepare and maintain tracking tools, spreadsheets, and reports related to eligibility status, renewals, discrepancies, and financial responsibility requirements.
Escalate complex eligibility, payer, agency, or participant financial responsibility concerns to the appropriate leader
Adhere to applicable CMS, state Medicaid, HIPAA, participant rights, enrollment, disenrollment, and organizational requirements.
Collaborate with Enrollment, Finance, Accounting, Operations, Executive Directors, clinical team members, and leadership to support timely and accurate eligibility outcomes.
Protect privacy and maintain confidentiality of participant, employee, referral, payer, and organizational information.
Identify opportunities to improve eligibility workflows, documentation accuracy, renewal timeliness, and participant experience.
Perform other duties and special projects as assigned.

Benefits

Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
Employer Paid Life Insurance
Paid Time Off - accruing from day one of employment
Floating Holidays
Paid Holidays
8 hours of Volunteer Time Off per year
401K with employer match
Wellness Program and Employee Assistance Program
Advancement opportunities (as appropriate) – we look to grow from within our organization
Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front