Eligibility Worker

Description

An Eligibility Worker in the Case Managers department focuses on verifying the eligibility of participants in the CalAim Community Support Program (CS). CS services are free and help members with complex health issues that may be caused or worsened by a lack of housing, food, or transportation. Community Supports assist Medi-Cal beneficiaries in establishing a basic household and maintaining safe, stable housing. 

WHAT YOU'LL DO:

Eligibility Worker is responsible for verifying client eligibility for Community Supports (CS) program participation, coordinating and maintaining service referral records, obtaining, tracking, and maintaining appropriate documentation on authorizations to support both Housing Navigators and Clients.

Eligibility Worker coordinates and ensures the smooth flow of the referral to meet the needs of the billing and reimbursement team, works with Elica patients and future clients referred by MHPs who may qualify for CS services, and understands precisely how to verify patient coverage so that Elica can bill properly for CS services.

The CS team is a part of the Social Care Department and works in close collaboration with ECM and other support programs.

BENEFITS:

• Retirement Savings Made Easy: Enjoy a 403(b) retirement plan with up to 4% employer matching and 100% immediate vesting—start building your future from day one!
• Comprehensive Healthcare Options: Choose from two Anthem Blue Cross PPO plans for medical, plus dental and vision coverage for you and your family.
• Employer-Funded HRA: Our Health Reimbursement Arrangement helps cover out-of-pocket medical costs, giving you peace of mind.
• Flexible Spending Accounts: Take advantage of two FSA options: Health Care FSA and Dependent Care FSA, tailored to suit your needs.
• Security for the Unexpected: We provide company-paid basic Life and AD&D Insurance, with options to enhance coverage.
• Enhanced Protection: Explore additional benefits like Hospital Indemnity, Critical Illness, and Accident Insurance, plus ID Theft Protection and Pet Insurance.
• Time to Recharge: Enjoy accrued paid time off, paid holidays, and Employee Assistance Plan (EAP) access, which includes counseling, financial, and legal services, along with a vast library of online resources.
• Invest in Yourself: Benefit from our Tuition Reimbursement Program for ongoing education and growth, plus CME/CEU and license reimbursements for eligible roles.

This is more than just a benefits package—it’s a commitment to your health, well-being, and professional success! 

Learn more about Elica’s services and mission at our website or check us out on Facebook.    

Requirements

WHAT ARE WE LOOKING FOR?

The successful candidate will be willing and able to:

• Perform pre-outreach activities for new clients referred by Managed Care Plans (MCPs), such as verifying eligibility, adding an appropriate Guarantor Account and Episode to EHR.
• Independently manages 3 CS Referrals EPIC WorkQueues by actively monitoring referral statuses and processing new referrals.
• Tracks the status of authorization requests.
• Tracks and resubmits re-authorization requests as required by MCPs by coordinating with Housing Navigators.
• Coordinates with the Reimbursement Specialist regarding authorizations issued by MCPs and checks issued to landlords/vendors by Elica.
• Checks eligibility of members in outreach and enrolled programs stage at the minimum of twice a month.
• If a patient switches MCPs and Elica is in contract with MCP for CS, submits and tracks prior-authorization.
• If the patient loses coverage, is no longer enrolled into any MCPs, or switches MCP to one not contracted for CS services, notifies an appropriate Housing Navigator to work with the patient on either regaining coverage or transferring to Health Plan for reassignment to a contracted provider.
• For patients internally referred to CS, checks patient eligibility for contracted CS services.
• Provides accurate data entry of referral or authorization information into the electronic medical record.
• Maintains consistent attendance and punctuality.
• Other duties as assigned.

The successful candidate has:

• A minimum of an Associate degree in any field.
• A minimum of one year of experience with CalAIM programs.
• Prior experience using Electronic Health Records systems – Epic preferred.
• Computer and technology skills.
• Excellent computer skills in a Microsoft Windows environment, including knowledge of Excel and skills in Google Workspace.
• Knowledge of the functions, operation, and mission of the specific department.
• Better-than-average written and spoken communication skills.
• General knowledge of various MHPs and state programs.
• Excellent organizational and time management skills.
• Ability to work with minimal supervision and use good judgment, at times under the pressure of deadlines.
• Adherence to all Elica policies, including but not limited to: standards of conduct, time and attendance.

Additional Requirements:

• Must have a current and valid California driver’s license and the ability to provide proof of personal auto insurance on the vehicle driven during working hours.
• If selected for an employment opportunity with Elica Health Centers, external hires must provide proof of immunizations (Hepatitis B, MMR, Varicella & Tetanus), tuberculosis clearance, and proof of COVID-19 vaccination status* prior to their scheduled start date. Please be advised that this position is subject to criminal background investigation and drug screen.

Physical Requirements and Work Environment:

The work environment is characteristic of normal office conditions. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit and use hands to handle or lift. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment can range from quiet to moderately loud; the incumbent must be able to focus in an environment with many distractions. The employee may be required to run agency-related errands and attend off-site meetings. The employee must be able to operate, maneuver, and/or control a motor vehicle. In performing the driving responsibilities, the driver may sit for long periods. This requires intense concentration, particularly in poor driving conditions. 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

*Elica Health Centers is a healthcare facility that adheres to the mandates issued by the California Department of Public Health including the recent orders regarding the COVID-19 vaccine. Medical and religious exemptions will be considered.

Salary : $25