Description

 Who We Are

Are you interested in working for an organization whose mission it is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?

Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.

Job Summary

Under the supervision of the Eligibility Supervisor, the Eligibility Specialist is responsible for resolving accounts receivable pertaining to participants’ eligibility and enrollment issues. The Eligibility Specialist will ensure the goals and objectives of the Finance department are achieved while abiding to state and federal rules and regulations. This position is expected to be highly collaborative by working closely with other departments such as the Claims, Intake, and Social Work teams to remedy any eligibility/enrollment issues. 

Essential Job Functions

· Monitor participant eligibility/enrollment status as provided by state and federal agencies such as the Department of Health Care Services (DHCS) and the Center for Medicare and Medicaid Services (CMS)

· Track eligibility/enrollment changes daily for documentation purposes

· Track Medicare eligibility dates for all participants and work with Intake to ensure timely enrollment

· Assist with retrospective and prospective enrollment/disenrollment efforts

· Initiate and maintain proper follow-ups with DHCS and CMS to ensure timely processing and completion of all mandated applications and accompanying documentation Maintain knowledge of eligibility and enrollment requirements for individuals participating in the Program of All-inclusive Care for the Elderly (PACE), including but not limited to out-of-area issues, Share of Costs (SOC), Primary Aid Codes, and excluded benefits

· Update enrollment/eligibility databases and other tracking spreadsheets including but not limited to Medi-Cal/Medicare eligibility issues

· Assist all departments in confirming/verifying participant eligibility/enrollment status for internal and external inquiries for coordination of care

· Attend and participate in staff meetings, in-services, projects, and committees as assigned

· Adhere to and support the company practices, procedures, and policies including assigned break times and attendance

· Accept assigned duties in a cooperative manner and perform all other related duties as assigned.

· Be flexible in schedule of hours worked 

· Accept assigned duties in a cooperative manner and perform all other related duties as assigned

· May require use of personal vehicle

Requirements

Knowledge, Skills and Abilities 

• Proficient knowledge of computer skills, including Microsoft Office (Word, PowerPoint, and Outlook)

• Knowledge of general office procedures, equipment, and filing systems

• Ability to communicate effectively, both orally and in writing

• Ability to quickly learn department policies, procedures, goals, and services

• Attention to detail and accuracy

• Ability to change priorities regularly

• Ability to think critically, take initiatives, and work independently with minimal supervision

• Highly organized and ability to retrieve information quickly

Working Conditions and Physical Demands 

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to access all areas of the center throughout the workday.

• Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds.

• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.

• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.

Experience

• Minimum of two (2) years of professional experience in managed care organizations, required without an Associate’s Degree

• Experience in the health care field, preferred 

Education and Certification 

• Associate’s Degree, required without professional experience

• Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact

Core Values

• Respect at the core of our interactions.

• Honesty and Integrity with every endeavor

• Patient – Centered care aligned with participant values, beliefs, and preferences. 

• Encouragement that motivates and empowers others to be the best they can be. 

• Quality Care that is efficient, transformative and innovative.