PACE Patient Benefits Navigator

Description

Esperanza Health Centers offers benefits to all its full-time employees:

BCBS Medical PPO Plans| Ameritas Dental |Eye Med Vision| Tuition Reimbursement up to $5,000 per year|10 Paid Holidays and 16 Days of Paid Time Off

Compensation (Based on experience and qualifications): $19.00-$23.00

What is PACE?

PACE, or Program of All-Inclusive Care for the Elderly, is an alternative care model for those over 55 years of age living at home but meeting nursing home level of care which aims to keep participants living safely in the community. PACE is a collaborative, interdisciplinary approach which coordinates all levels of medical and social needs, including prevention, wellness, socialization, primary care, and access to specialists and other services.?

Position purpose: The PACE Benefits Navigator is responsible for guiding prospective and current Panorama PACE participants with understanding and managing the financial aspects of enrollment in PACE. This includes verifying eligibility for Medicare, Medicaid, and other payer sources, determining any financial obligations associated with enrollment, and assisting with applications and renewals. The PACE Benefits Navigator works seamlessly with the PACE enrollment team and Esperanza finance department to ensure timely and accurate financial assessments while maintaining compliance with all program regulations.

Primary Duties And Responsibilities

• Assist participants and families in determining financial eligibility for Medicaid, Medicare, and the PACE program.
• Verify prospects' current Medicare, Medicaid, or private insurance coverage; educate prospects and representatives about requirements and address any questions or concerns.
• Guide participants through the Medicaid and Medicare application processes, as applicable, including gathering and submitting required documentation in an expeditious manner, and following through until process is completed.
• Collaborate with state and federal agencies to monitor application status and resolve eligibility issues.
• Track due dates for Medicaid recertifications for all enrolled Panorama PACE participants, assisting participants and their representatives through the process, and ensuring that all documentation is accurate and submitted before the recertification deadline.
• Provide clear and thorough explanations of PACE program benefits, including coverage, eligibility, enrollment timelines, participant fees, and out-of-pocket expenses.
• Work with prospective and existing PACE participants and PACE finance department to meet monthly spenddown requirements according to state requirements for PACE.
• Counsel participants on how to manage assets and resources to maintain Medicaid eligibility, including spenddown obligations.
• Accurately document financial assessments, Medicaid applications, and eligibility verification in the designated system.
• Maintain compliance with state, federal, and PACE program financial requirements.
• Generate and review financial reports to track eligibility, program costs, and participant status.
• Work closely with the enrollment, social work, and clinical teams to support a seamless enrollment process.
• Act as a liaison between participants, families, internal teams, and external agencies to resolve financial eligibility issues.
• Assist with outreach efforts by providing financial guidance at community events, orientations, and informational sessions.
• Stay current with Medicaid, Medicare, and PACE program regulations and changes in financial eligibility policies.
• Ensure confidentiality of all participant financial and personal information in compliance with HIPAA regulations.
  
  

The PACE Benefits Navigator will provide cross coverage and support for PACE Outreach Representative functions, relating to enrollment process, as required.

Requirements

• Bilingual- English/Spanish required
• High School Diploma or GED required.
• Associate’s or Bachelor’s degree in Finance, Business Administration, or related field preferred.
• Minimum 2 years of experience in financial counseling, Medicaid eligibility, or healthcare billing.
• Previous experience with Medicare, Medicaid, and Marketplace benefit coverage and enrollment required.
• Experience with insurance eligibility software preferred.
• Excellent interpersonal, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to prioritize tasks and to delegate them when appropriate.
• Subject matter expert in PACE federal and state-specific eligibility requirements.
• Detail-oriented with strong organizational and time management skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Experience with enrollment, billing, or financial software preferred.
• Problem-solving and organizational skills with the ability to prioritize tasks.
  
  

Salary Description

$19.00-$23.00