Eligibility & Financial Determination Specialist

Care Synergy•Aurora, CO

17h•Onsite

About The Position

Colorado PACE has an opening for an Eligibility & Financial Determination Specialist in Aurora, CO. This full-time role involves reviewing and preparing Medicaid applications, ensuring compliance with Colorado Medicaid rules and regulations, and serving as the primary point of contact for Medicaid application processes. The specialist will also troubleshoot complex eligibility cases, collaborate with various teams and County Human Services, and monitor private pay participants. The position is with Care Synergy, a network of mission-driven, nonprofit healthcare organizations dedicated to caring for very ill, frail, and primarily elderly individuals by keeping them at home and out of the hospital while maximizing comfort, dignity, and quality of life. Care Synergy provides significant community impact through hospice, home health, palliative care, CAPABLE, wellness, and PACE programs.

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

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
Overtime
Mileage and Expense Reimbursement: Sixty-two and a half cents per mile