Eligibility Services Representative

Colorado Access•Denver, CO

1d•$51,600 - $56,240•Hybrid

About The Position

Colorado Access is seeking an Eligibility Services Representative to process Long Term Care (LTC) applications and help clients understand eligibility requirements and provide documentation needed for timely determinations. The representative assists applicants by telephone, mail, and in person; reviews income, financial, and supporting documents; conducts interviews; determines periods of ineligibility when resources have been transferred; and works with state disability contractors and Single Entry Point agencies when needed. The role uses the Colorado Benefits Management System (CBMS) to enter information, process applications, maintain cases, and ensure accuracy, quality, privacy, and security. The representative also answers client calls, documents interactions, works with community providers and facilities, and provides objective information about Connect for Health Colorado marketplace plans and enrollment resources. Client service is available Monday through Friday, 8:00 a.m. to 5:00 p.m., except during office closures or scheduled department training. The position is hybrid, combining in-office and remote work, and Colorado Access cannot support employees based outside Colorado. The position is non-exempt (hourly), with annual compensation of $51,600 to $56,240.

Requirements

High school diploma required.
Client service experience and experience determining medical eligibility within CBMS.
One year of experience determining Long-Term Care Medicaid eligibility.
Professional face-to-face communication and the ability to work in a call center environment while responding professionally to inquiries.
Excellent client service for internal and external clients and effective communication with diverse clients.
Excellent written and verbal communication, problem-solving, attention to detail, and organizational skills.
Ability to work independently in a high-volume environment and manage multiple priorities and projects with tight deadlines.
Ability to use CBMS to support quality outcomes and resolutions for clients, providers, and Colorado Access.
Training Certification from the Colorado Health Care & Economic Security Staff Development Center, obtainable before or after hiring and required within 90 days of employment.
Valid driver's license and proof of current auto insurance.

Nice To Haves

Associate’s degree in health, social services, or additional college courses.
Bilingual Spanish/English.
Knowledge of local health and community agencies and providers.

Responsibilities

Process Long Term Care applications and educate clients about information and documentation needed for timely eligibility determinations.
Gather and review income, financial, and supporting documentation, including bank statements, trust documents, and real estate records, to determine eligibility accurately.
Conduct client interviews to verify information, identify potentially fraudulent documentation, and determine periods of ineligibility when resources have been transferred within the prior five years.
Work with the state disability contractor, the Action Review Group, to determine whether clients meet the Social Security Administration definition of disability when necessary.
Work with Single Entry Point agencies to begin ULTC100 forms for functional eligibility determinations.
Enter data and process applications in CBMS, maintaining accuracy, quality, security, and privacy.
Process applications and case updates within state-contract time frames and perform ongoing case maintenance.
Use resource materials, policies, procedures, handouts, databases, and training to ensure accurate, high-quality processing.
Meet assigned production, quality, and client-service standards; attend training and participate in internal and external performance audits.
Assist clients professionally and ethically while protecting Protected Health Information and following state guidelines.
Coordinate with community providers and facilities about client case status or changes, and educate them on program rules and regulations as needed.
Answer incoming calls, research and resolve inquiries or concerns, provide accurate information, and document interactions in the client management system.
Provide client service Monday through Friday, 8:00 a.m. to 5:00 p.m., except during office closures or scheduled department training.
Provide accurate, objective information to customers and prospective customers about Connect for Health Colorado marketplace plans and enrollment resources.

Benefits

Paid time off, floating holidays, and nine company-paid holidays.
Hybrid work environment.
Employee Assistance Program.
401(k) retirement plan.
Tuition reimbursement, subject to eligibility.
Leadership training, promotion opportunities, performance evaluations, and employee recognition.
Language pay stipend.
Medical, dental, and vision insurance beginning the first day of the month following the start date.
Supplemental critical illness and accidental injury insurance.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D coverage for the employee, spouse, and dependents.
Short-term and long-term disability coverage.
Voluntary life insurance for the employee, spouse, and dependents.
Annual bonus program, subject to eligibility, requirements, and performance.