Medi-Cal Eligibility and Provider Enrollment

Foothill Family•Pasadena, CA

18d•$30 - $37

About The Position

The Medi Cal Eligibility & Provider Enrollment Coordinator ensures client eligibility verification and maintenance of benefits in addition to timely enrollment, maintenance, and revalidation of Los Angeles County Department of Mental Health (LADMH) program providers. This role serves as a key operational link between providers, LACDMH, county social services agencies, and delegated entities to ensure continuity of care and compliance with Medi Cal and contract requirements. This role ensures uninterrupted access to care for clients and accurate provider enrollment set-up and regulatory compliance to minimize claims denials.

Requirements

Bachelor’s degree in healthcare administration, public health, or related field preferred.
Minimum of 2–4 years’ experience in Medi Cal eligibility and/or Medi Cal provider enrollment, preferably within a county health plan or COHS environment.
Working knowledge of Medi Cal, Medicare, and commercial payer requirements and county-based health plan operations.
Proficiency with enrollment systems, payer portals, CAQH, and electronic health or practice management systems.
Experience interacting with county eligibility offices, DMH and/or DHCS systems, and Medi Cal provider enrollment processes.
Strong attention to detail and ability to manage multiple priorities in a highly regulated environment.
Effective written and verbal communication skills for working with providers, county partners, and internal stakeholders.
Valid CA Driver’s License and maintains insurability on the Agency’s auto liability policy (including a minimum of 2 years driving experience) and maintains the California state required auto insurance liability limits OR maintains reliable transportation to attend all appointments and meetings as required in the position.

Nice To Haves

Bilingual in Spanish highly preferred.

Responsibilities

Supports and promotes the mission of the Agency: Foothill Family empowers children and families on their journey to achieve personal success.
Manages Medi Cal Member Eligibility.
Verifies and monitors Medi Cal member eligibility, aid codes, effective dates, and health plan assignment using Medi Cal and county eligibility systems.
Identifies and resolves eligibility issues related to plan enrollment, county to county transfers, retroactive eligibility, and eligibility interruptions.
Coordinates closely with County Social Services/Eligibility Offices, LACDMH systems, and internal enrollment teams to resolve discrepancies.
Supports eligibility validation processes required for claims payment, care coordination, and continuity of services.
Documents eligibility determinations and resolutions accurately in LACDMH and related county systems.
Provides education and guidance to clients, providers, care management teams regarding Medi Cal eligibility rules, benefit coverage, and enrollment timelines.
Completes Medi Cal Provider Enrollment & Network Maintenance
Coordinates initial Medi Cal provider enrollment in the Provider Application for Validation and Enrollment (PAVE), Network Adequacy: Provider and Practitioner Administration (NAPPA) and the National Plan and Enumeration System (NPES), and revalidation, demographic updates, and disenrollment in accordance with state and LACDMH requirements.
Prepares, submits, and tracks Medi Cal provider enrollment and revalidation applications through the LACDMH enrollment systems and applicable managed care portals. This task may include Medicare enrollment in CMS Provider Enrollment, Chain and Ownership System (PECOS) and/or CAQH enrollment as needed.
Verifies required provider credentials, including California licensure, NPI, taxonomy, DEA registration (as applicable), malpractice insurance, and specialty documentation.
Tracks enrollment status and follow up with LACDMH, fiscal intermediaries, and delegated entities to resolve deficiencies, denials, or delays.
Ensures providers are properly enrolled with Medi Cal which includes enrollment in PAVE, NAPPA and NPES prior to rendering services to members.
Maintains accurate provider enrollment and credentialing data in health plan systems to support claims, encounters, and network reporting.
Monitors and tracks provider licensure, revalidation cycles, sanctions, exclusions, and corrective action requirements.
Attends in-person meetings and events at various locations within the Los Angeles County and surrounding areas.
Provides services relating to the administration of public funds or benefits, including eligibility for public funds or public benefits.
Displays sensitivity to the service population’s cultural and socioeconomics characteristics.
Performs work in a safe manner at all times and ensures employees are abiding by safety practices; takes action when employees put themselves or others at risk.
Follows all policies, procedures and legal mandates including HIPAA, client confidentiality, releases of information, protected health information (PHI) and client files.
Ensures staff follow all policies, procedures and legal mandates including HIPAA, client confidentiality, releases of information, protected health information (PHI) and client files, and applies appropriate coaching, counseling and disciplinary action to reinforce staff compliance.
Ensures performance and behaviors support the Agency’s performance quality improvement (PQI) goals and objectives.
Reports to work on time and maintains reliable and regular attendance.
Performs other duties as assigned.