Eligibility & Coverage Advocate
About The Position
At WelbeHealth, we’re transforming the reality of senior care by providing an all-inclusive healthcare option to our most vulnerable senior population, functioning as both a care provider and care plan to those we serve. The Eligibility & Coverage Advocate is the liaison between participants and the WelbeHealth center team, and is accountable for assisting enrolled participants in maintaining eligibility for state and federal benefits they are entitled to such as SSI, Medicaid, and Medicare. The Eligibility & Coverage Advocate will support the Eligibility & Reconciliation (E&R) team to ensure accurate and timely resolution of eligibility issues with minimal direction, and to prioritize daily scope of work requests, inquiries, turnaround times, and items that need escalation.
Requirements
- High school diploma or equivalency
- Minimum of three (3) years of relevant Medi-Cal/Medicaid enrollment experience, including share of cost, spousal impoverishment protections, and appeals processes
- Experience working directly with the county DPSS submitting, managing, and appealing Medi-Cal enrollments
- Demonstrate in-depth experience with complex Medi-Cal enrollment case management, and knowledge of Medi-Cal rules, processes, and practices
- Strong interpersonal skills, comfortable speaking to seniors in a caring manner
Nice To Haves
- Bilingual (Spanish/English) strongly preferred
Responsibilities
- Proactively identify participants coming up for Medi-Cal redetermination
- Educate and assist participants with the completion of all necessary forms, and ensure appropriate signatures are obtained
- Conduct visits to participants’ homes to complete forms when necessary
- Assist with obtaining all documentation required for eligibility determination or redetermination
- Complete and file applications by initiating and maintaining proper follow-ups with participants, center staff, and government agencies to ensure timely processing and completion of all mandated applications and accompanying documentation
- Maintain a strong working relationship with the Department of Public and Social Services (DPSS) to ensure compliance with DHCS and CMS policies and procedures
Benefits
- 401k + employer match
- Medical insurance coverage (Medical, Dental, Vision)
- 17 days of personal time off (PTO)
- 12 holidays observed annually
- 6 sick days
- Additional benefits
- Competitive total rewards package
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
