PACE Eligibility Specialist
Company: San Ysidro Health
Posted on: January 7, 2021
PACE Eligibility Specialist
1830 / 1840 West Drive, 1830 / 1840 West Drive, Vista, California,
United States of America Req #2542
Thursday, December 24, 2020
Under the supervision of the Enrollment Department Supervisor, the
Benefits Specialist will provide clinic in-reach, eligibility
education, enrollment navigation and retention assistance aimed at
support individuals/families in obtaining and retaining health care
Areas of Responsibility:
- Assists individuals in applying and retaining health coverage
by collecting required and accurate personal and demographic
information; determining eligibility; assessing needs; providing
accurate information regarding health coverage options;
uploading/submitting verification documents and completing
- Complete and submit health coverage applications. Initiate and
maintain proper follow-up with patient and government agency to
ensure timely processing and completion of all mandated
applications and accompanying documentation.
- Completes and submits required reports related to
- Ensure and follow up as needed on all reports and activities
that must be completed related to Medi-Cal (AKA Medicaid)
eligibility (i.e. maintain records on active PACE census, tracks
dis-enrollments, proper reporting to DHCS/CMS, update TruChart and
work with various team members of PACE to ensure accuracy on all
- Create and update "active enrollment" excel
- Review all active participants Medi-Cal eligibilities
- Upload all eligibilities with "Medi-Cal issues" to eligibility
- Check off and notate required fields on active enrollment excel
- Update Procedure Code in DHCS website for all participants with
Share of Cost monthly, update "SOC spreadsheet"
- Compose a list of all participants that have Medi-Cal issues
along with notes
- Enter participants names and Medi-Cal issues to financing
spreadsheet "insurance report"
- Add newly assigned Medicare participants MBI numbers to finance
spreadsheet and Truchart, assign SDP as health plan on CMS
- Email insurance report to appropriate representative(s) in the
- Report Medicaid issues list via email to assigned Social Worker
and assigned CES
- CES and Social Work team coordinate appointment for
participants with Medicaid issues to assist with Medi-Cal
application and resolution of any issues to Medi-Cal
- Request Medicaid status updates from CES (on scheduled PACE
days) and Social Worker
- Check update on Medi-Cal website as often as possible
- Assist participants with Medi-Cal renewal packets to prevent
loss of Medi-Cal
- Upload enrollment agreements and chart notes (from Truchart)
for participants with change to health plan, create an encrypted
email with uploaded documents to DHCS (James Vo and Sam Haddad) for
- Verify participant is still active with SD PACE prior to
- Initiates and Mmonitors and initiates health coverage
redetermination/renewal process for patients. Completes Medi-Cal
Renewal Package, CCA Renewal Process, Reports all changes on active
accounts, Medi-Cal Add-Ons, Referrals.
- Facilitates referral to SYH and community resources for
assistance with other needs and intricate issues.
- Maintains accurate and thorough records of all activities.
Prepares statistical reports and patient/client correspondence.
Submit monthly report by the 1st of every month.
- Provides responsive, high quality service to PACE participants,
SYH employees, representative of County and outside agencies and
members of the public by providing accurate, complete and
up-to-date information in a courteous, efficient and timely
- Provide follow-up activities as needed to ensure PACE
participants obtain and retain health coverage. A high focus will
be on assisting high-acuity patients requiring more intensive
assistance (i.e. senior, or adult with disability) to ensure there
is no lapse in coverage.
- Conducts clinic in-reach and education activities, individually
and in group, to SYH patients and community members at clinic
locations and other community locations about PACE services. Submit
any in-service reports to Enrollment Department
- Supports Enrollment Department Team Supervisor with on-site
training for new staff when requested. Following proper procedures
and training templates provided by Enrollment Supervisor.
- When needed, accompanies potential and/or active PACE
participants (i.e. social security offices, etc.) to obtain needed
documentation that will assist in gauging eligibility for
- Maintains and updates (as needed) new PACE participant
- Monitors the monthly dis-enrollments and communicates
information to appropriate staff. Provides information and refers
participants dis-enrolling from PACE to appropriate entities that
are able to assist Assists patients with forms processing and
maintains the Share Folder electronic Log.
- Assists in the maintenance of the EKG Logs.
- Ensures that all lab reports, correspondence, referrals, etc.,
are sent out timely to the Satellite Clinics, when
- Works in collaboration with other clinical care Providers and
the HIS team for positive customer service, and providing
assistance to any other HIS areas, as needed for smooth
- Assists in the supervision, maintenance, revision of
established department policies and procedures, promotes abiding by
Core Values, preparation of work schedules, assignment of staff,
assists in appropriate education, training, and guidance of staff,
and evaluation of work performance and productivity, making
recommendations for staff actions.
- Ability to proficiently maneuver through all electronic
applications used for job.
- Performs any other job-related duties as needed, assigned
and/or as requested.
- Adheres to SY Health and HIS Department's policies and best
practices, ensuring staff compliance to attendance and
Additional Duties and Responsibilities:
- Complies with all department, organization and government
policies & procedures.
- Attends meetings and trainings as required.
- Performs other related duties as assigned or requested.
High School Diploma or GED equivalent required.
Bachelor Degree in a health or human service field.
CA driver's license with appropriate automobile insurance required.
Must pass the Covered California criminal background check. Must
take and pass the State of California DHCS PACE and Medi-Cal
Marketing Certification exam within 60 days of hire and two exams
1) Certified Enrollment Counselor (CEC) exam and 2) SYH Eligibility
Competency Exam within the 90-day probationary period.
A minimum of 2 years of experience performing eligibility
assistance, case management, referrals or related function. Related
education may substitute for experience. A minimum of 1 year
working with and/or assisting seniors.
Verbal and Written Skills to Perform the Job:
Must have excellent oral and written communication skills.
Technical Knowledge and Skills 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, have
good computer/tablet literacy including internet navigation and
- 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.
San Ysidro Health is a Federally Qualified Health Care organization
committed to providing high quality, compassionate, accessible and
affordable healthcare services for the entire family.
The organization was founded by seven women in search of medical
services for their families and community. Almost 50 years later,
San Ysidro Health now provides innovative care to over 92,000
patients through a vast and integrated network of 34 program sites
across the county. San Ysidro Health could not serve our patients
without the dedication of our passionate and hardworking
Apply today and become a part of our mission-driven team!
San Ysidro Health has a long-standing commitment to equal
employment opportunity for all applicants for employment.
Employment decisions including, but not limited to, those such as
employee selection, performance evaluation, administration of
benefits, working conditions, employee programs, transfers,
position changes, training, disciplinary action, compensation, and
separations are made without regard to reace, color, religion
(including religious dress and grooming), creed, national origin,
nationality, citizenship status, domestic partnership status,
ancestry, gender, affectional or sexual orientation, gender
identity or expression, marital status, civil union status, family
status, age, mental or physical disability (including AIDS or
HIV-related status), atypical heredity cellular or blood trait of
an individual, genetic information or refusal to submit to a
genetic test or make available the results of a genetic test,
military status, veteran status, or any other characteristic
protected by applicable federal, state, or local laws.
Keywords: San Ysidro Health, Vista , PACE Eligibility Specialist, Other , Vista, California
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