Eligibility & Financial Determination Specialist

Care Synergy • Aurora, CO

11h • Onsite

About The Position

Colorado PACE is seeking an Eligibility & Financial Determination Specialist for a full-time position in Aurora, CO. This role is crucial for ensuring timely eligibility decisions for participants by managing Medicaid applications, maintaining compliance with Colorado Medicaid rules, and collaborating with various teams and external agencies. The specialist will serve as a primary contact for Medicaid application processes, troubleshoot complex cases, and provide regular updates to leadership. The organization, part of the Care Synergy network, is dedicated to providing compassionate care for ill, frail, and elderly individuals, focusing on home-based care. The company fosters a culture of engagement, community, and work-life balance, offering a supportive environment and robust benefits.

Requirements

• High School Diploma or equivalent
• Prior experience working with the frail and elderly population in a healthcare setting.
• 2 years' experience in Medicaid eligibility, financial determination, or benefits coordination.
• 1 year experience working with CMS and strong knowledge of Colorado Medicaid Benefits.
• Valid Colorado Driver’s License and proof of auto insurance.

Responsibilities

• Reviews/prepares Medicaid applications and partners with the Enrollment Team and PACE Interdisciplinary Team (IDT) to obtain all required financial and personal documentation needed for timely eligibility decisions.
• Serves as the primary point of contact regarding Medicaid application processes, best practices, and ongoing training.
• Maintains a tracking system for all submitted applications from initial submission through approval, providing regular updates to the Director of Business Development, PACE Center Director(s) and PACE Executive Director.
• Ensures all applications comply with Colorado Medicaid rules and regulations, including updates to Health First Colorado, Long-Term Care (LTC) Medicaid, Spousal Impoverishment provisions, Trusts, Old Age Pension (OAP), and related Medicaid programs applicable to PACE participants.
• Collaborates with Accounts Receivable to monitor and resolve monthly Medicaid-related issues for PACE participants.
• Monitors private pay participants and supports seamless transitions to Medicaid eligibility when appropriate.
• Ensures all eligibility staff maintain current knowledge of Medicaid policies and application processes.
• Responds promptly to adverse action notices, including 10-day notices, denials, and requests for additional information from County Human Services.
• Troubleshoots complex eligibility cases in partnership with Enrollment Team and IDT.
• Provides regular updates to Director of Business Development, PACE Center Director(s) and PACE Executive Director on application status, assisting with questions, barriers, and required follow-up.
• Collaborates with County Human Services, Social Workers, Intake, and PACE interdisciplinary teams to resolve eligibility, financial classification, and documentation issues.
• Demonstrates leadership by modeling professionalism, providing guidance, and supporting positive morale and teamwork within the Enrollment team.

Benefits

• We value engagement, community, and outreach initiatives and know it matters for our team members and our patients. We provide welcoming and supportive care to our patients and a work environment where all team members feel respected and valued.
• We support a culture of work-life balance and provide team members with two, free, confidential and robust benefit programs designed to provide solutions to the logistical and financial problems that arise in life.
• Employer pays over 90% of employee medical premium in some plans
• Health Savings Account (HSA) with significant Employer Funding: Single $1,000, Family $2,000
• Extensive Paid Time Off (PTO/Vacation Pay/Sick Leave): 18 days in the first year for FT team members
• Seven Paid Holidays with an additional Floating Holiday
• 403(b) Retirement Plan with Employer Match: 50% match up to 8% of total compensation
• Company-Paid Life and AD&D Insurance
• Career & Logo wear
• Education Reimbursement Program
• Clinical Career Ladders
• Certification Pay
• Generous Discover-a-Star Team Member Referral Program
• Team Member Service Awards
• Early Wage Access
• Legal and Identity Protection
• Robust Leadership Development Training Programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees