Long Term Care (LTC) Eligibility Processor

Colorado Access•Denver, CO

6d•Onsite

About The Position

Colorado Access is a Colorado-based company dedicated to improving the health of the state by serving individuals, families, and children who receive healthcare through Child Health Plan Plus (CHP+) and Health First Colorado. The organization focuses on enhancing quality, member experience, outcomes, and cost. It is a mission-driven organization with a vision, values, and a commitment to diversity, equity, and inclusion. The company offers work-life balance through PTO, floating holidays, paid holidays, a hybrid work environment, an Employee Assistance Program, and a 401K. Employees contribute to serving underserved and vulnerable populations by providing access to quality, affordable healthcare, making a tangible impact on the community. Colorado Access supports employee development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

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.
Excellent written and verbal communication skills.
Proven problem-solving skills.
Attention to detail.
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.
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.
Works 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.