Job Description

Job Location Colorado Springs Explorer Location - COLORADO SPRINGS, CO 80920 Position Type Full Time Education Level None Salary Range $22.10 - $25.42 Hourly

Travel Percentage Up to 50% Job Shift Day Job Category Health Care

The Eligibility Advocate is responsible for establishing and maintaining Medicaid eligibility for program participants by coordinating with all payor sources. This position is Rocky Mountain Health Care’s (RMHCS) liaison to the Department of Human Services (DHS) and the single-entry point (SEP) and coordinates with these departments to expedite and track eligibility requirements ensuring timely Medicaid approvals and revenue protection This includes all eligibility evaluations and ongoing documentation that maintains participant eligible for the program. A successful Eligibility Advocate is self-motivated, detail-oriented, extremely well organized and possesses in-depth knowledge of Medicaid/Medicare requirements and processes.

MISSION Improving lives, Optimizing wellness, Promoting independence

COMPETENCIES:

• Technical Expertise
• Problem Solving
• Teamwork
• Effective Communication
• Results Oriented
• Personal Credibility
• Quality Focus
• People Focus
• Flexibility

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

• Autonomously initiates Medicare, SNAP, and/or Long-Term Care Medicaid Waiver application process for potential participants. This includes but is not limited to application completion, assistance with gathering and processing verification items, application submission, and coordination with SEP case managers to ensure functional eligibility.
• Consistently tracks and follows-up on application status to ensure timely enrollment, smooth transition of care, maintenance of tracking database, and increased company census.
• Regularly reviews Colorado Benefits Management System (CBMS) and contacts the Department of Human Services’ (DHS) office to obtain eligibility status on new and currently enrolled participants. Updates department specific trackers to maintain accurate records of all current and potential participants.
• Serves as the initial and regular point of contact with potential participants, current participants, and appropriate representatives for all items/areas related to eligibility as well as community resources.
• Provides consistent professional written and verbal communication with community partners, participants, and appropriate representatives. Documents these encounters in the Electronic Health Record to retain accurate auditable files.
• Requests and tracks requests for records and other required documentation from doctors’ offices, financial institutions, retirement and investment companies, insurance companies/burial policy issuers, property assessors, social security offices, veteran’s affairs, prior participant employers, and others.
• Assists participants and/or their appropriate representatives with establishing income trusts at a financial institution of their choice when appropriate and confirming validity directly with state partner, Health Care Policy and Finance (HCPF). Coordinates the joint appointment with financial institutions and calculates required monthly deposits.
• Independently and as appropriate guides clients and their representatives through Medicaid compliant spenddowns when requested to maintain eligibility.
• Coordinates appropriate disability applications through the Medicaid appointed Action Review Group (ARG). Tracks disability determination and regularly communicates results with participant, ARG, and DHS and leadership of Intake and Enrollment.
• Independently tracks on average 140-200 current participant’s recertification (RRR) annually to ensure there is no lapses in coverage year to year. This includes but is not limited to coordinating with the SEP to complete Continued Stay Review (CSR) packet, revalidating all required documentation and applications through DHS, and working all cases out of pending status for outstanding items and/or information.
• Supports RMHCS finance department in validation of Medicaid payments through monthly case management of outstanding accounts receivable cases. This includes working closely with DHS and HCPF to correct cases, validate finances, and/or guide participants through needed documents.
• Independently maintain and updates participant shared payments for Assisted Living Facilities (ALF) or Skilled Nursing Facilities (SNF). Uses participant’s recording income to calculate payment due to facility and individual’s personal needs allowance. Conducts semiannual liability project to validate data, reviews with current participants, obtains signatures, files in participant records, provides to claims, and sends to applicable facility.
• 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.
• Maintains professional affiliations and any required certifications.
• Performs other duties as assigned.

ORGANIZATIONAL (CORE RATING FACTORS):

• Demonstrates support of the Company’s Mission, Vision and Core Values
• Provides Exceptional Customer Service
• Ensures discretion with confidential information in accordance with HIPAA guidelines
• Supports a collaborative work environment including courteous, helpful and professional behavior
• Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
• Adheres to and supports all Company policies and procedures
• Supports and practices safe work habits in accordance with policies and procedures
• Brings ideas, problems and concerns forward and participates in resolution and implementation
• Participates in and completes regulatory compliance trainings within the prescribed deadlines
• Attends required meetings
• Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency

Qualifications

• Associate’s degree or equivalent experience in customer service in a human services environment, business, or comparable education and experience required
• Thorough understanding of the DHS, Medicaid, VA, and Social Security programs and processes
• Certified Medicaid Professional I (MCMP-I) highly desired
• Extensive knowledge of community resources available to older adults and their families
• Case Management experience highly desired
• Strong time management, organization, and attention to detail
• Ability to effectively and independently represent the program to participants, families, outside agencies, community groups, community professionals and the general public
• Minimum of 1 year of experience working with the frail and/or elderly populations preferred
• Experience working with an Electronic Health Record preferred