Eligibility Advocate

POSITION SUMMARY: The Eligibility Advocate is responsible for establishing and maintaining Medicaid eligibility for participants by coordinating with all payor sources. This position is Rocky Mountain Health Cares (RMHCS) liaison to Department of Human Services (DHS) and the single-entry point (SEP) and coordinates with these departments to expedite and track eligibility requirements. This includes all eligibility evaluations and ongoing paperwork that keeps participants eligible for the program. A successful Eligibility Advocate is self-motivated, detail-oriented and possesses in-depth knowledge of Medicaid/Medicare requirements and processes. This position is eligible for a quarterly bonus.

MISSION: Improving lives, Optimizing wellness, Promoting independence

Responsibilities And Duties

ESSENTIAL JOB FUNCTIONS:

• Initiates Medicare, Social Security, Long-Term Care Medicaid Waiver application process for potential participants, including application completion, assisting applicants with gathering and processing verification items, application submission, and coordination with SEP case managers, tracking and follow-up of application status
• Provides initial telephone point of contact with potential participants and participants family/care giver and referral sources as needed
• Completing home visits as necessary to aid in the process of establishing and then maintaining eligibility
• Regularly checks Colorado Benefits Management System (CBMS) or visits DHS office to obtain eligibility status on eligible and enrolled participants and updates tracking sheets
• Conducts consistent professional written and verbal communication with referral sources, and documents these communications in the Electronic Health Record
• Requests and tracks requests for records and other required paperwork from doctors offices, and other sources
• Maintains Medicaid Tracking database including tracking time to approval from submission to approval by DHS, and all other statuses as needed/required
• Prepares a variety of periodic and special reports, which may require gathering data from several sources, compiling such data, and arranging it into proper format
• Prepares the DSS-1s from DHS and tracks the participants recertification (RRR) with DHS to make sure they are approved year to year
• Prepares the Continued Stay Review (CSR) packet and tracks the participants CSR in coordination with SEP
• Supports RMHCS finance department in validation of Medicaid payments and revenue cycle as needed and requested by Management
• Completes and records initial and annual verifications of participants incomes
• Maintains and updates participant shared payments for Assisted Living Facilities (ALF) or Skilled Nursing Facilities (SNF)
• Coordinates intake of new participants as necessary
• Maintains professional affiliations and any required certifications
• Performs other duties as assigned
• Associates degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of DHS, Medicaid, VA, and Social Security processes
• Certified Medicaid Professional (CPM) highly desired
• Extensive knowledge of community resources available to seniors and their families
• Case Management experience highly desired
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• 1 year experience working with the frail and/or elderly populations preferred
• Experience working with an Electronic Health Record preferred
  
  

We strive to provide our employees with a comprehensive and affordable benefits package including Medical and Prescription Drug, One Medical, Dental, Vision Care, Wellness Program, Telemedicine Program, Flexible Spending Accounts, Health Savings Account, Company Paid Basic Life and Accidental Death & Dismemberment, Company Paid Long-Term Disability, Voluntary Life Insurance, Voluntary Short-Term Disability, Accidental Injury Insurance, Critical Illness, Hospital Indemnity, 403(b) Savings Plan, Legal Shield and IDShield, Employee Assistance Program (EAP), Paid Time-Off plan. Such benefits are based on applicable state law and factors such as pay classification (full-time, part-time, or PRN/casual), job grade and length of service.