Long Term Care (LTC) Eligibility Processor

Colorado Access•Denver, CO

7d•$51,600 - $58,240•Onsite

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

Requirements

High school diploma required.
Minimum of two years’ experience determining medical eligibility within CBMS.
One year determining Long-Term care Medicaid Eligibility experience.
Demonstrates professionalism with face to face interactions with clients.
Able to effectively communicate with diverse clients.
Demonstrates support for the company’s mission, vision and values.
Position requires excellent written and verbal communication skills, proven problem-solving skills and attention to detail and excellent organizational skills.
Able to work independently in a high-volume environment
Requires the ability to use the Colorado Benefits Management System (CBMS) to facilitate quality outcomes and or resolutions for the benefit of clients, providers and Colorado Access.
May be required to manage multiple priorities and projects with tight deadlines.
Training Certification from the Colorado Health Care & Economic Security, the Staff Development Center. This certification can be acquired before or after hiring and must be obtained within 90 days of employment.
A valid driver's license and proof of current auto insurance will be required.

Nice To Haves

Associates degree in health, social services or additional college courses preferred.
Bilingual (Spanish/English) preferred.
Knowledge of local health and community agencies and providers preferred.

Responsibilities

Serves as primary eligibility resource to process Long Term Care (LTC) applications for clients by educating clients on information needed for a timely determination and by gathering income documentation, financial documentation and other necessary supporting information. Provides assistance with the application process telephonically, via mail and in person.
Provides superior client service to clients including but not limited to eligibility requirements for verifying documentation such as bank statements, trust documents and real estate records, etc. to determine eligibility accurately.
Conducts thorough interviews with clients to verify accuracy of information and to determine and/or rule out fraudulent documentation. Determines periods of ineligibility (POI) if any resources have been given away by the client in the past five years.
Per the State requirements, LTC processors will work in conjunction with the state disability contractor, the Action Review Group (ARG), to determine if the client meets the Social Security Administration definition of a disability when necessary.
Works closely with Single Entry Point agencies to begin ULTC100 forms for functional eligibility determination for clients requesting Long Term Care services.
Utilizes the State’s CBMS system to enter data and process all applications to determine eligibility while holding the highest regards to accuracy, quality, security and privacy of the CBMS system.
Processes all applications including in person, mailed in or dropped off applications in the required time frames mandated by the State contract, this includes all aspects of case updates as reported by the client and ongoing case maintenance activities.
Utilizes resource materials, policies and procedures, handouts, databases and training opportunities to ensure accuracy and quality of all aspects of application processing.
Meets individual performance production requirements, quality and client service standards as assigned by the department management team.
Attends all trainings and participates in internal and external performance audits to ensure compliance with quality standards.
Assists clients in a professional, ethical manner following State guidelines to ensure the privacy of Protected Health Information.
Works with Community Providers / Facilities regarding changes or status of individual client cases when necessary. Develop relationships with Community Providers / Facilities and educate them on program rules and regulations as needed.

Benefits

PTO
floating holidays
nine company paid holidays
a hybrid work environment
an Employee Assistance Program
a 401K
tuition reimbursement
leadership training
promotion opportunities
performance evaluations
employee recognition
a language pay stipend
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Annual bonus program (based on eligibility, requirements and performance).