Eligibility & Financial Determination Specialist - PACE

Eligibility & Financial Determination Specialist - PACE

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Colorado PACE has an opening for an Eligibility & Financial Determination Specialist.

Location: Aurora, CO

Status: Full-time

Schedule: Monday-Friday, 8-5

Hourly Pay Range: $19.29 - $22.50

Supplemental Pay: Based on position, schedule and/or availability:
Overtime

Mileage and Expense Reimbursement: Sixty-two and a half cents per mile – one of the highest in the industry!

• We value engagement, community, and outreach initiatives and know it matters for our team members and our patients. We provide welcoming and supportive care to our patients and a work environment where all team members feel respected and valued.
• We support a culture of work-life balance and provide team members with two, free, confidential and robust benefit programs designed to provide solutions to the logistical and financial problems that arise in life.
• Low healthcare premiums: we have not increased our team member medical rates 4 out of the last 5 years
• Employer pays over 90% of employee medical premium in some plans
• Health Savings Account (HSA) with significant Employer Funding:
  Single $1,000, Family $2,000
• Healthcare Benefits are effective on the 1st of the month following date of hire
• Extensive Paid Time Off (PTO/Vacation Pay/Sick Leave) and EIB (Extended Illness Bank): 18 days in the first year for FT team members
• Seven Paid Holidays with an additional Floating Holiday
• 403(b) Retirement Plan with Employer Match: 50% match up to 8% of total compensation
• Company-Paid Life and AD&D Insurance
• Career & Logo wear
• Education Reimbursement Program
• Clinical Career Ladders
• Certification Pay
• Generous Discover-a-Star Team Member Referral Program
• Team Member Service Awards
• Early Wage Access
• Legal and Identity Protection
• Robust Leadership Development Training Programs

• Reviews/prepares Medicaid applications and partners with the Enrollment Team and PACE Interdisciplinary Team (IDT) to obtain all required financial and personal documentation needed for timely eligibility decisions.
• Serves as the primary point of contact regarding Medicaid application processes, best practices, and ongoing training.
• Maintains a tracking system for all submitted applications from initial submission through approval, providing regular updates to the Director of Business Development, PACE Center Director(s) and PACE Executive Director.
• Ensures all applications comply with Colorado Medicaid rules and regulations, including updates to Health First Colorado, Long-Term Care (LTC) Medicaid, Spousal Impoverishment provisions, Trusts, Old Age Pension (OAP), and related Medicaid programs applicable to PACE participants.
• Collaborates with Accounts Receivable to monitor and resolve monthly Medicaid-related issues for PACE participants.
• Monitors private pay participants and supports seamless transitions to Medicaid eligibility when appropriate.
• Ensures all eligibility staff maintain current knowledge of Medicaid policies and application processes.
• Responds promptly to adverse action notices, including 10-day notices, denials, and requests for additional information from County Human Services.

• Troubleshoots complex eligibility cases in partnership with Enrollment Team and IDT.
• Provides regular updates to Director of Business Development, PACE Center Director(s) and PACE Executive Director on application status, assisting with questions, barriers, and required follow-up.
• Collaborates with County Human Services, Social Workers, Intake, and PACE interdisciplinary teams to resolve eligibility, financial classification, and documentation issues.
• Demonstrates leadership by modeling professionalism, providing guidance, and supporting positive morale and teamwork within the Enrollment team.

• Minimum Education:
  
  High School Diploma or equivalent
• Minimum Experience:
  
  Prior experience working with the frail and elderly population in a healthcare setting. 2 years' experience in Medicaid eligibility,…