Eligibility Specialist The Program of All-Inclusive Care for the Elderly (PACE) offers a variety of services, with many of them provided onsite at a PACE Center. PACE is an alternative to nursing home care and – through an interdisciplinary care team (IDT) of physicians, nurse practitioners, nurses, social workers, therapists, van drivers, and aides – coordinates and provides preventive, primary, acute, and long-term care services, so older individuals can continue living in the community. Why You'll Love it Here: - Purpose
- Professional Development
- Paid Holidays
- PTO and Sick Time
- Internal opportunities for growth
- Team Support
| - Competitive Pay
- Medical, Dental, Vision Insurance
- Life insurance
- 403(b) Retirement Savings
- Employee Assistance
- And MORE!
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At Senior Care Partners. PACE, we're committed to helping older adults remain independent and thrive in their homes and communities. As an Eligibility Specialist, you'll play a critical role in guiding participants and their families through the Medicare and Medicaid eligibility process, ensuring they receive the benefits and services they need with compassion, accuracy, and efficiency. If you're detail-oriented, enjoy helping others navigate complex processes, and have experience with Medicaid eligibility, we'd love to hear from you. What You'll DoAs an Eligibility Specialist, you'll be responsible for managing the Medicare and Medicaid eligibility process for prospective and current PACE participants. Working closely with our Enrollment Coordinator, DHHS staff, Social Workers, and interdisciplinary care team, you'll ensure applications and redeterminations are completed accurately and on time. Key Responsibilities- Process Medicare and Medicaid applications and redeterminations in accordance with federal, state, local, and organizational guidelines.
- Educate prospective participants, families, caregivers, physician offices, and referral sources about Senior Care Partners PACE and available services.
- Collaborate with Enrollment Coordinators following in-home assessments to facilitate participant eligibility.
- Assess Medicare and Medicaid eligibility and assist individuals in obtaining Medicaid benefits.
- Maintain accurate documentation related to participant eligibility and benefits.
- Manage multiple participant eligibility requests while tracking deadlines and required follow-up.
- Coordinate annual Medicaid redeterminations and address unique eligibility situations throughout the year.
- Maintain accurate Medicare and Medicaid enrollment status for participants.
- Assist with eligibility and benefit documentation during transitions of care.
- Monitor application timelines to ensure timely processing and enrollment.
- Deliver exceptional customer service using a patient- and family-centered care approach.
- Partner with DHHS workers, Social Workers, and internal team members to ensure accurate eligibility determinations.
What We're Looking ForRequired Qualifications- High school diploma or equivalent.
- Minimum of one (1) year of experience processing DHS/Medicaid applications; long-term care Medicaid experience preferred.
- At least one (1) year of experience working with frail older adults or the long-term care population.
- Strong understanding of Medicare and Medicaid eligibility requirements.
- Excellent organizational skills with exceptional attention to detail.
- Strong written and verbal communication skills.
- Ability to maintain confidentiality and exercise sound judgment.
- Proficiency with Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
- Proven administrative and organizational skills with the ability to manage multiple priorities.
Additional Requirements - Must be fully vaccinated or willing to become vaccinated against:
Influenza, MMR, Varicella, Tdap/Td, COVID-19, and Hepatitis B - Must meet CMS competency standards prior to working independently
- Must be willing to work beyond normal hours and take part in our on-call rotation
- Comfortable working in varied home environments and all weather conditions
Join Us! If you’re ready to do meaningful work in a place where you feel you truly belong, where partnership drives every interaction, and where excellence and ownership guide how we care for our participants and one another, we invite you to apply. Senior Care Partners PACE is proud to be an Equal Employment Opportunity employer.
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