Eligibility Specialist

McGregor PACE (Program of All-Inclusive Care for the Elderly) is a community service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing seniors to remain at home.

We are looking for an Enrollment Coordinator who will be responsible for submitting the Medicaid application and required verifications for PACE applicants to establish Medicaid eligibility and act as the applicant’s Medicaid Authorized Representative.

Responsibilities:

• Determines Medicaid eligibility for PACE applicants.
• Acts as Medicaid Authorized Representative for McGregor PACE applicant 
• Arranges initial and ongoing home visits with applicants and/or families related to obtaining necessary authorizations and verifications for Medicaid eligibility determination. 
• Completes the Medicaid application and submits required verifications to the Special Medicaid Benefits Center (SMBC) for Medicaid eligibility determination.
• Follow up on all aspects of the applicant’s Medicaid application process with SMBC and other organizations to obtain needed verifications to determine eligibility for Medicaid benefits.
• Consistent communication with the Director of Enrollment and staff regarding progress or delays that affect applicants' program eligibility.
• Documents all activities during the Medicaid application and enrollment process.
• Participates in meetings as appropriate, including the weekly Intake Meeting and weekly Team Meeting. Other meetings as assigned.

• Serves as a resource to participants, families, and McGregor PACE staff for Medicaid eligibility.
• Completes routine reports and paperwork.
• Completes the temporary insurance card and welcome packet for newly enrolled/confirmed PACE participants and informs applicant/family of status.
• Upload the temporary insurance card and welcome packet to Electronic Medical Record.
• Once the applicant is confirmed by ODA, ensure their electronic file is complete and ready to be transferred to the Eligibility Department.
• Other duties as assigned.

Minimum Qualifications:

• Valid driver’s license and reliable transportation required.
• Excellent verbal/telephone/written communication skills.
• Basic proficiency in MS Word, PowerPoint; Excel, Access database/spreadsheet applications.
• Flexible, energetic, reliable, goal / detail-oriented individual with the ability to prioritize workloads.
• Ability to work collaboratively with staff at all levels.

Preferred Qualifications:

• Bachelor’s degree preferred.
• One year experience in home or community-based Medicaid waiver programs and health/social services programs preferred.
• At least one year of experience working with older adults, especially dementia, preferred.
• Up-to-date working knowledge and some experience in Ohio Medicaid and Federal Medicare regulations/systems preferred.
• Knowledge of basic Medicaid criteria is highly desirable. 

We offer competitive compensation and EXCELLENT BENEFITS which include: