Eligibility & Financial Redetermination Lead

InnovAge•Charlottesville, VA

2d•$52,000 - $65,000

About The Position

The Lead Eligibility and Financial Redetermination is responsible for providing exceptional customer service to participants and their representatives as well as timely coordination of all aspects of the redetermination process. This role is responsible for the annual redetermination processing of Medicaid, which includes obtaining and collecting all necessary documentation to maintain ongoing Medicaid eligibility. The Lead also trains new staff on the Redetermination team and provides support to the team in the absence of the Eligibility and Financial Redetermination Supervisor. Other duties and training may be assigned or delegated by the Supervisor or Manager.

Requirements

High School diploma or GED required.
A minimum of three years’ total experience.
Current knowledge of the Medicaid system/benefits in addition to community resources that are available to seniors and their families.
A minimum of two years working with the frail or elderly is required.
Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.
Able to establish and maintain cooperative and positive working relationships.
Organized, detail-oriented, courteous, proactive, self-motivated, dependable, and excellent customer service skills.
Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
A minimum of 5 years working in the Long-Term Care Medicaid Field
Strong problem-solving skills
Possess strong interpersonal and verbal communication skills
Proven track record of being able to handle difficult situations with diplomacy and professionalism
Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

Responsibilities

Completes all re-determinations for their assigned case load on or before the required due date, performing this task via home visit or day center visit to accommodate the participant and/or family or caregiver.
Assists the participant/family/POA with obtaining, compiling, and collecting all necessary paperwork and documentation needed to maintain Medicaid eligibility.
Tracks and documents all performed tasks via case notes in the participant’s record. Ensures all documents are scanned and indexed into the appropriate database. Organizes caseload and working area in an efficient manner that allows information to be accessed when not available.
Interprets and communicates rules and regulations of Long-Term Medicaid, Spousal Impoverishment, and Trusts to participants and families/POA in a way that is easily understood.
Works closely with county technicians to respond to any notices or any other adverse notices of action.
Gives immediate attention to any new cases on the Aging Report and advises the supervisor of any notice of disenrollment that need to be sent out.
Completes supportive housing forms on an as needed basis. Requests and follows through on cases that require a county transfer.
Updates the county if a participant has moved and a county transfer is required. Follows up with the county to ensure the home address, the mailing address and the county transfer has been completed.
Completes disenrollment forms and submits to the county technician as required.
Assists with problem cases, troubleshooting and offering training and guidance.
Demonstrates superior time management and organization skills.
Acts as the back up for Eligibility and Financial Redetermination Representatives on an as needed basis including when Representatives are behind or are out on leave.
Demonstrates a deeper level of Long-Term Care Medicaid knowledge and shares knowledge with staff.
Demonstrates superior knowledge in all areas of the Medicaid Redetermination process.
Assists the Eligibility and Financial Redetermination Supervisor and Manager with training of staff.
Demonstrates a commitment to the quality improvement process and adheres to the philosophy of continuous improvement; identifies and responds actively and with sensitivity to the needs of all concerned; participates as a team player in all phases of the organization; and is open and responsive to change.
Communicates and interacts in a professional manner.
Maintains strict confidentiality of personnel data, proprietary information, and sensitive materials as required.
Maximizes cost efficiency and productivity in the use of all resources of the department and organization.
Attends all required department events, staff meetings, and any other job-related functions. Attends and successfully completes all mandatory trainings.
Does not communicate with any news media or volunteer business information to other agencies. Directs public relations issues to the appropriate person.
Does not enter any contract without approval which commits the organization to any obligation, or which transfers company assets to any outside interests, or which involve expenditures of a capital nature.
Performs within position and personal limitations and provides information to employees, co-workers, business contacts, and others only as able and appropriate for position.