Eligibility & Financial Determination Special

InnovAge•Pine Castle, FL

3d•$47,200 - $59,000•Onsite

About The Position

The Eligibility & Financial Determination Specialist works in conjunction with the Enrollment Representatives in overseeing the Medicaid applications being submitted on behalf of InnovAge PACE Participants to the County Technicians. This role involves significant administrative duties (80%) related to reviewing applications, ensuring documentation is complete for Medicaid approval, and acting as a primary contact for training and best practices. The specialist will maintain a tracking system for applications, ensure compliance with State Medicaid Rules and Regulations, and collaborate with Accounts Receivable and the Medicaid Controller/Analyst to track monthly Medicaid issues. They will also track private pay clients for a smooth transition to Medicaid eligibility and ensure all IGCP Medicaid staff maintain necessary Medicaid knowledge. Immediate attention is required for 10-day notices, denial notices, or other adverse notices of action. The role also includes participant Medicaid enrollment (20%), troubleshooting difficult cases, updating enrollment representatives on application status, and dealing with eligibility and classification issues in collaboration with County Human Services staff, Social Workers, Intake, and other IGCP staff. The specialist will also demonstrate leadership to motivate and direct enrollment representatives.

Requirements

3+ yrs total related experience
1+ yr with CBMS Medicaid systems and knowledge of Medicaid system and benefits
High School diploma or GED
Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.

Nice To Haves

Bachelors Degree

Responsibilities

Reviews applications from the Enrollment Representative Group and works closely with them in obtaining necessary documentation needed for Medicaid approval.
Works as the primary contact for the enrollment representative for ongoing training and best practices.
Maintains a tracking system in place and provided to the Medicaid Controller showing applications received and the status of each application from first submission to approvals.
Ensures compliance with all State Medicaid Rules and Regulations with applications being submitted by Innovage to the County Agencies by keeping current on updates of Federal and State rules and regulations that pertain to Medicaid, Straight Medicaid, LTC, Spousal Impoverishment and Trusts, Food Stamps, Old Age Pension (OAP) and other Medicaid programs for which IGCP participants may be eligible.
Works with Accounts Receivable and the Medicaid Controller/Analyst to track on a monthly basis Medicaid issues with IGCP participants.
Tracks private pay clients and instrumental in obtaining a smooth transition to Medicaid eligibility.
Ensures that all IGCP Medicaid staff acquires and maintain the necessary Medicaid knowledge needed for the position in collaboration with the Medicaid Redetermination Manager and the Medicaid Controller.
Provides immediate attention to 10 day notices and denial notice or any other adverse notices of action received on new applications that were submitted to the county technicians.
Troubleshoots difficult cases with Enrollment Representatives and Eligibility & Financial Determination Specialists.
Works extensively with the enrollment representatives to update them on the status of their applications and to assist with any questions, concerns or roadblocks.
Deals with eligibility and classification issues in collaboration with the County Human Services staff, Social Workers, Intake and other IGCP staff.
Demonstrates by example and leadership to provide motivation and direction to the enrollment representatives on an as needed basis to ensure positive moral and teamwork.