Eligibility Specialist

INNOVATIVE INTEGRATED HEALTH•Bakersfield, CA

11d•$20 - $24•Onsite

About The Position

Under the supervision of the Eligibility Supervisor, the Eligibility Specialist is responsible for resolving accounts receivable pertaining to participants’ eligibility and enrollment issues. The Eligibility Specialist will ensure the goals and objectives of the Finance department are achieved while abiding to state and federal rules and regulations. This position is expected to be highly collaborative by working closely with other departments such as the Claims, Intake, and Social Work teams to remedy any eligibility/enrollment issues.

Requirements

Proficient knowledge of computer skills, including Microsoft Office (Word, PowerPoint, and Outlook)
Knowledge of general office procedures, equipment, and filing systems
Ability to communicate effectively, both orally and in writing
Ability to quickly learn department policies, procedures, goals, and services
Attention to detail and accuracy
Ability to change priorities regularly
Ability to think critically, take initiatives, and work independently with minimal supervision
Highly organized and ability to retrieve information quickly
Minimum of two (2) years of professional experience in managed care organizations, required without an Associate’s Degree
Associate’s Degree, required without professional experience
Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact

Nice To Haves

Experience in the health care field, preferred.

Responsibilities

Monitor participant eligibility/enrollment status as provided by state and federal agencies such as the Department of Health Care Services (DHCS) and the Center for Medicare and Medicaid Services (CMS)
Track eligibility/enrollment changes daily for documentation purposes
Track Medicare eligibility dates for all participants and work with Intake to ensure timely enrollment
Assist with retrospective and prospective enrollment/disenrollment efforts
Initiate and maintain proper follow-ups with DHCS and CMS to ensure timely processing and completion of all mandated applications and accompanying documentation
Maintain knowledge of eligibility and enrollment requirements for individuals participating in the Program of All-inclusive Care for the Elderly (PACE), including but not limited to out-of-area issues, Share of Costs (SOC), Primary Aid Codes, and excluded benefits
Update enrollment/eligibility databases and other tracking spreadsheets including but not limited to Medi-Cal/Medicare eligibility issues
Assist all departments in confirming/verifying participant eligibility/enrollment status for internal and external inquiries for coordination of care
Attend and participate in staff meetings, in-services, projects, and committees as assigned
Adhere to and support the company practices, procedures, and policies including assigned break times and attendance
Accept assigned duties in a cooperative manner and perform all other related duties as assigned.
Be flexible in schedule of hours worked
Accept assigned duties in a cooperative manner and perform all other related duties as assigned
May require use of personal vehicle.