Eligibility Specialist
- Works with and assists PACE SEMI staff, specifically the Billing Specialist, for/with Medicaid application process, Medicaid recertification process, Medicare needs and Disenrollment Process.
- Collects necessary information for program eligibility, including at the participant’s home if necessary.
- Documents and records all efforts and steps taken, including dates during the application or recertification process for each PACE SEMI candidate or enrollee.
- Works with state agencies on all Medicaid issues affecting current PACE SEMI participants, including but not limited to recertification, over resource issues or food stamp issues.
- Communicates professionally and appropriately with PACE SEMI staff members, participants or prospective participants, PACE SEMI Contractors and State Agency employees, at all times.
- Keeps confidential, all PACE SEMI participant information, and/or all other information pertaining to PACE SEMI participants, issues or business practices.
- Provide quality services to participants.
- Ensures compliance to departmental and external standards in the provision of quality focused care by attendance at professional meetings/committees and review of national standards of practice.
- Other duties as assigned.
- Complete understanding of PACE SEMI PACE, including all aspects of qualifying new participants.
- Provide assistance to Intake department through telephone screening, education, document preparation, provide tours of facilities, and coordination of potential participants.
- College degree preferred.
- Minimum of High School diploma with familiarity with government funded programs.
- Knowledge of government benefits programs and other related social service programs.
- At least 1 year experience in a Medicaid field is preferred.
- Computer literate.
- Demonstrated ability to follow-through on planned tasks or activities, involving tracking, documentation, distribution, facilitation and communication.
- Established ability to make decisions independently, to influence others and resolve issues.
- Ability to recognize the types of issues and/or when to escalate an issue to a more senior project team member.
- Recognized ability to work both independently and as a member of a team.
- Proven organization skills to multitask while maintaining attention to detail and meeting deadlines.
- Effective communication skills both verbal and written.
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