PNW PACE Eligibility Coordinator

MultiCare Health System•Tacoma, WA

2d•Onsite

About The Position

The Eligibility Coordinator is responsible for receiving and tracking referrals. After receipt of referral(s), the Eligibility Coordinator will evaluate PACE eligibility, including financial eligibility and communicate eligible referral with the Enrollment Specialist. The Eligibility Coordinator evaluates eligibility using identified resources including Medicaid eligibility processing, other community resources, and DSHS eligibility (financial and review of CARE assessment). This position is responsible for communicating marketing materials to local referral sources and review PACE eligibility and program standards. This position requires interpretation of information relating to regulatory and statutory requirements, ability to adjudicate insurance benefits and coverage and interpret viability of financial assistance programs. Independent decisions are required within the scope of responsibilities, which impact sources of revenue. Internal contacts include Enrollment Specialist, Executive Director, Clinical Director and the PACE team. External contacts include patients/patients’ families, referral sources including physicians and staff in offices, insurance companies, and state and local agencies.

Requirements

Minimum one (1) year in health care related eligibility, collection, financial counseling or billing experience required
Demonstrated competency with spreadsheet management and report development required

Nice To Haves

Marketing experience preferred
Minimum one (1) year experience working with a frail or elderly population preferred
Completion of a medical terminology course or proficiency preferred

Responsibilities

Receiving and tracking referrals.
Evaluating PACE eligibility, including financial eligibility.
Communicating eligible referrals with the Enrollment Specialist.
Evaluating eligibility using identified resources including Medicaid eligibility processing, other community resources, and DSHS eligibility (financial and review of CARE assessment).
Communicating marketing materials to local referral sources.
Reviewing PACE eligibility and program standards.
Interpreting information relating to regulatory and statutory requirements.
Adjudicating insurance benefits and coverage.
Interpreting viability of financial assistance programs.