Eligibility Specialist

Gary and Mary West Pace is a rapidly growing and successful all inclusive day center for the fragile elderly.

We are located in San Marcos, CA. This is a Monday through Friday-8:00AM to 4:30PM position.

We offer an excellent benefit package and a great 403B program and tuition re-imbursement.

Why Work for Gary and Mary West PACE?

Because you desire work/life balance and have a passion to make a difference in the lives of North County seniors and their families!

You will receive generous pay and a benefits program focused on your health and wellness that includes 10 paid holidays, 13 days of pto, 5 days of sick leave, a 5% employer-match to our 403b retirement program, and no on-call time.

Because we encourage professional development and support all staff to expand their skillset, providing an annual education allowance.

You will be part of a distinct company culture where work feels like family and collaborate with a multi-disciplinary team environment where you are appreciated and valued.

Come do your best work where your contribution matters!

About PACE

Philanthropists Gary and Mary West founded West Health with the mission of enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life, and independence. The Gary and Mary West PACE (Program of All-inclusive Care for the Elderly), affiliated with West Health (www.westhealth.org), is a new non-profit that delivers medical, social, and behavioral services to the frail elderly to the North County of San Diego. This PACE center will be entrepreneurial in nature and will focus on innovations and bringing new processes to the traditional PACE environment.

We're looking for passionate healthcare providers who want to be part of a team dedicated to enable seniors to live in their communities as independently as possible by providing compassionate, comprehensive health and supportive care.

One Team One Mission

Position Summary:
The Eligibility Specialist is responsible for assisting prospective and enrolled participants establish and maintain eligibility for benefits they are eligible for, such as SSI, Medi-Cal and Medicare. The Eligibility Specialist is a member of the Gary and Mary West PACE Finance Team and reports to the Director of Business and Finance.

Essential Functions:
•Assist prospective and enrolled participants in applying for benefits and resolving any eligibility issues with SSI, Medi-Cal and Medicare.
•Manage Part A and Part B applications during annual Medicare general enrollment period enabling collection of additional capitation.
•Develop positive relationships with the San Diego County Medi-Cal and Social Security Administration staff and the Department of Health Care Services staff.
•Initiate and maintain proper follow-up with the participant and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
•Understand, monitor and use State systems (e.g. POS and AEVS) effectively.
•Monitor GMW PACE participants' benefit status for application denials, eligibility discontinuances, and annual redetermination dates.
•Reach out and work with participants and families to complete Medi-Cal applications or annual redeterminations on time to avoid application denials or eligibility discontinuances.
•Partner with GMW PACE Social Workers in a collaborative manner to seek assistance obtaining necessary documentation for annual redeterminations.
•Partner with GMW PACE Social Workers in a collaborative manner to ensure all prospects disenroll from IHSS when applicable, prior to enrolling in PACE.
•Collaborate with the County of San Diego for required monthly IHSS reporting.
•Monitor participant placement transitions and obtain changes in benefits from SSA and/or Medi-Cal as applicable.
•Collaborate with the Enrollment and Marketing department to develop positive rapport with prospective participants and families.
•Complete all required documentation in a timely and accurate manner.
•Protect privacy and maintain confidentiality of all company procedures and information about employees, participants and families.
•Follow GMW PACE policies and procedures and participate in any required Quality Improvement activities, staff training and meetings.
•Other duties as assigned.

Education and Certification:
•HS Diploma or equivalent required.
•Current driver's license and proof of auto insurance required.

Skills & Experience:
•At least 2 years' experience working in an administrative support role.
•Proficiency with Microsoft Excel, Word and Outlook.
•Experience interacting with local government Medicaid or Social Security agencies preferred.
•Good written and verbal communication skills.
•Excellent organizational, customer service and communication skills in settings with seniors, their families and interdisciplinary team members.
•Highly motivated, self-directed, able to execute tasks in a quickly changing environment and make sound decisions in emergency situations.
•Commitment to unlocking the full potential of our most vulnerable seniors.
•Experience and competent working with people from diverse backgrounds.
•Bilingual Spanish English preferred.
•Original valid driver's license with proof of auto insurance.

Medical Clearance:
Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
Working Conditions and Physical Demands
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this role. In compliance with ADA requirements, reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

COVID-19 vaccination required. Must have an original valid Drivers License and proof of auto insurance.

Gary and Mary West PACE provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, gender, gender identity, gender expression or sexual orientation or any other considerations made unlawful by applicable state or local laws.

Salary : $23 - $26