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PACE Eligibility Specialist

Company: San Ysidro Health
Location: Vista
Posted on: January 7, 2021

Job Description:

PACE Eligibility Specialist
1830 / 1840 West Drive, 1830 / 1840 West Drive, Vista, California, United States of America Req #2542
Thursday, December 24, 2020
Position Summary:
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 coverage.

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 applications.
  • 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 PACE.
  • 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 eligibility issues).
  • Create and update "active enrollment" excel spreadsheet
  • Review all active participants Medi-Cal eligibilities bi-monthly
  • Upload all eligibilities with "Medi-Cal issues" to eligibility folder
  • Check off and notate required fields on active enrollment excel spreadsheet
  • 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 website
  • Email insurance report to appropriate representative(s) in the finance department
  • 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 eligibility.
  • 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 retro requests.
  • Verify participant is still active with SD PACE prior to sending request
  • 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 manner.
  • 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 Supervisor.
  • 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 benefits.
  • Maintains and updates (as needed) new PACE participant enrollment/eligibility packets.
  • 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 appropriate.
  • 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 operations.
  • 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 punctuality.

    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.

      Job Requirements:


      Education:

      • High School Diploma or GED equivalent required.
        Preferred:

        • Bachelor Degree in a health or human service field.
          Certifications/Licenses:

          • 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.

            Experience:

            • 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 research skill.
                  Competencies:

                  • 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.


                    About Us
                    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 employees.


                    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.
                    Other details
                    • Pay Type Hourly

Keywords: San Ysidro Health, Vista , PACE Eligibility Specialist, Other , Vista, California

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