PACE Eligibility Specialist

Position Summary:

Under the supervision of the Eligibility Supervisor, the Eligibility Specialist will assist participants/potential participants in obtaining Medi-Cal and Medicare Coverage to access PACE services.

Essential Functions of the Job:

• Assists individuals in applying for and retaining Medi-Cal and/or Medicare coverage. Collection of required information in a concise and accurate fashion.
• Assesses and discusses coverage options with all potential enrollees and participants for the best possible solution to eligibility issues.
• In collaboration with the potential enrollee or participant, submits applications in a timely manner in accordance with DHCS, County and/or CMS expectations.
• Completes and submits all reporting in an accurate manner.
• Ensures prompt and proactive follow-up on all assigned eligibility cases. May be required to work with PACE Social Services to remedy any/all eligibility issues.
• Initiates and monitors health coverage redetermination/renewal process for patients. Completes Medi-Cal Renewal Package, Reports all changes on active accounts, Medi-Cal Add-Ons, Referrals.
• Conducts in-services to educate and inform staff, participants and their families of eligibility processes and updates.
• Assists in orientation and training of new staff.
• If needed, accompany participants to external facilities to address eligibility issues (County Offices, Social Security Office, Bank etc.)

Additional Duties and Responsibilities:

• Complies with all department, organization, and government policies & procedures.
• Attends meetings and training courses as required.
• Performs other related duties as assigned or requested.

Job Requirements

Experience Required:

• A minimum of 2 years of experience performing eligibility assistance, case management, referrals, or related functions. Related education may substitute for experience.
• A minimum of 1 year working with and/or assisting seniors.

Education Required:

• High School Diploma or GED equivalent required.
• Preferred: Bachelor’s degree in a health or human service field.

Certifications Required:

• CA driver’s license with appropriate automobile insurance required.
• Must complete the training for the State of California DHCS PACE and Medi-Cal Marketing Guidelines within 60 days of hire.

Verbal and Written Skills Required to Perform the Job:

• Must have excellent oral and written communication skills.
• Bilingual (English/Spanish) is preferred but not required.

Technical Knowledge and Skills Required to Perform the Job:

• Knowledge of local, state, and federal public health assistance programs and respective policies and regulations.
• Proficient in Microsoft applications and use of electronic health data systems including NextGen, CalWin, CalHEERS, TruChart.
• At a minimum, must have good computer/tablet literacy including internet navigation and research skills.
• Demonstrated ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service
• Self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines
• Provide prompt, efficient and responsive customer service.

Equipment Used:

• Computers, iPads/tablets, phones, personal vehicle, copy machines, fax machines, and other general office equipment.

Working Conditions and Physical Requirements:

• May be required to lift to 30 lbs., stand and walk frequently indoors and outdoors; set-up/take down outreach equipment.
• Will be required to travel to other sites or other locations within San Diego County.
• Will be required to work some evenings, weekends, or Holidays.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.