Eligibility & Financial Determination Special

InnovAge•Denver, CO

2d•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 reviewing applications, ensuring documentation for Medicaid approval, providing training and best practices to enrollment representatives, and maintaining a tracking system for application status. The specialist must ensure compliance with all State Medicaid Rules and Regulations, staying current on updates related to various Medicaid programs. They also work with Accounts Receivable and the Medicaid Controller/Analyst to track monthly Medicaid issues and track private pay clients for a smooth transition to Medicaid eligibility. Additionally, they ensure Medicaid staff maintain necessary knowledge and provide immediate attention to adverse notices of action. In addition to administrative duties (80%), the role includes Participant Medicaid Enrollment (20%), where the specialist troubleshoots difficult cases, updates enrollment representatives on application status, deals with eligibility and classification issues in collaboration with county staff, and provides motivation and direction to 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 showing applications received and the status of each application from first submission to approvals.
Ensures compliance with all State Medicaid Rules and Regulations.
Keeps 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.
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.
Provides immediate attention to 10 day notices and denial notice or any other adverse notices of action received on new applications.
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.