Eligibility & Financial Determination Lead

Eligibility And Financial Determination Lead

The Eligibility And Financial Determination Lead works in conjunction with the Enrollment Representatives in reviewing the Medicaid applications being submitted on behalf of Innovage PACE applicants to County Technicians. They are responsible for providing exceptional customer service to applicants and their representatives as well as timely review and tracking of applicants during the enrollment process.

Administration 80%

• Train new staff on the Specialists team as well as provide support to the team in the absence of the supervisor.
• Reviews applications from Enrollment Representatives and works closely with them in obtaining necessary documentation needed for Medicaid approval. Works as the primary contact for the Eligibility Specialists for ongoing training and best practices.
• Ensures tracking system in place to track applications and the status of each application from first submission to approvals. To include private pay participants, transition to Medicaid as pay source.
• Ensures compliance with all State Medicaid Rules and Regulations with applications being submitted by Innovage to the County Agencies. Fulfilling this by keeping current on updates of Federal and State rules and regulations that pertain to Medicaid, Straight Medicaid, LTC, Spousal Impoverishment and Trusts, Food Stamps, Old Age Pension (OAP) and other Medicaid programs for which IGCP participants may be eligible.
• Works with Accounts Receivable and their supervisor with trouble shooting case issues.
• Ensures that all IGCP staff acquire and maintain the necessary Medicaid knowledge needed for the position. Assists with training and re training/guidance of staff as needed.
• Immediate attention to VCL (10-day notices) and denial notice or any other adverse notices of action received on new applications that were submitted to the county technicians.

Participant Medicaid Enrollment 20%

• Troubleshoots difficult cases with Enrollment Representatives and Eligibility & Financial Determination Specialists
• Works extensively with the Eligibility Specialists and Enrollment Representatives to update them on the status of their applications and to assist with any questions, concerns, or roadblocks.
• Works with eligibility and classification issues in collaboration with the County Human Services staff, Social Workers, Intake and other IGCP staff.
• Demonstrates by example and leadership to provide motivation and direction to the Eligibility Specialists on an as needed basis to ensure positive moral and teamwork.

Required: 4+ yrs total related experience, 2+ yrs with CBMS Medicaid system and current knowledge of Medicaid systems and benefits, 2+ yrs working with the frail or elderly. Preferred: Bachelors degree.