Eligibility Advocate Lead

• Technical Expertise
• Problem Solving
• Teamwork
• Effective Communication
• Results Oriented

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

• Main point of contact for DHS regarding Medicaid and Medicare issues for RMHCS.
• Main point of contact for Social Work/RM PACE staff regarding Medicaid and Medicare issues.
• Provides new information/training to Intake and Enrollment teams, in conjunction with the Intake & Enrollment Manager.
• Contributes to end of month enrollment reporting and ongoing account receivable reporting.
• Conducts internal audits of Medicaid and Medicare per the direction of the Intake & Enrollment Manager.
• Responsible for training new Eligibility Advocates in conjunction with Intake & Enrollment Manager.
• Responsible for training plan and documentation to be approved by Intake & Enrollment Manager for Eligibility Advocate position(s).
• At the request of the Intake & Enrollment Manager, may contribute data in performance appraisals of Eligibility Advocate(s).
• Supports and contributes to Finance Department validation of payments and revenue cycle as needed and requested by Intake & Enrollment Manager.
• 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-1’s from DHS and tracks the participant’s recertification (RRR) with DHS to make sure they are approved year to year
• Prepares the Continued Stay Review (CSR) packet and tracks the participant’s 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.

KEY PERFORMANCE INDICATORS:

• Maintains an annual closure rate of less than 5%.
• Attends at least one continuing education workshop per quarter to enhance knowledge in Medicaid/Medicare or to keep abreast of changes in federal/state regulations.
• Completes 100% of RRR and CSR on an annual basis.

• Associate 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 I (MCMP-I) 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