Medi-Cal Eligibility Specialist

Role Scope: 

This is an opportunity for a highly motivated and detailed oriented individual that is responsible for supporting prospective participants and existing participants navigate Medi-Cal eligibility and redeterminations. This individual will work closely with Habitat Health’s Outreach & Enrollment to support prospective participants apply for Medi-Cal eligibility, follow-up on application status, and answer questions that prospective participants may have. This individual will also work with Habitat Health’s Health Plan team to help existing participants navigate redeterminations. This role requires a combination of excellent customer service skills, attention to detail, deep understanding of Medi-Cal eligibility and redetermination, and proficiency in managing and processing multiple Medi-Cal eligibility and redetermination applications.   

• Partner with center staff, health plan, and outreach & enrollment to triage Medi-Cal status issues that affect PACE eligibility 

• Track Medi-Cal application pipeline to inform Growth and Health Plan operations 

• Gather all necessary documentation to create, submit, pursue, and appeal Medi-Cal eligibility for prospective participants and existing participants for re-eligibility / redetermination with Medi-Cal  

• Visit senior’s homes as needed to gather necessary documentation to submit complete applications and redeterminations  

• Maintain a strong working relationship with the County and Local social service agencies (e.g., DPSS) to ensure seamless enrollment and re-eligibility workflow, adhere to deadlines and ensure compliance with DHCS and CMS guidelines and policies  

• Create and conduct Medi-Cal eligibility events at Habitat Health Centers, with community partners, and virtual sessions.   

Qualifications:  

• Minimum of three (3) years of experience working directly with the county DPSS submitting, managing, and appealing Medi-Cal eligibility and redeterminations  

• Demonstrate in-depth knowledge of Medi-Cal rules, processes, practices, and options for Medi-Cal eligibility and redetermination  

• Demonstrated knowledge and experience with complex Medi-Cal eligibility and redetermination case management  

• Excellent verbal and written communication skills  

• Willing to work weekends as necessary, particularly for community events   

• Proof of medical clearance for communicable diseases, including a TB test  

• Proof of all immunizations is up to date  

• Proof of valid CA driver’s license, personal transportation, good driving record and auto insurance as required by State law 

Nice to have: 

• Bilingual (Spanish/English) strongly preferred  

• A minimum of one year experience working with the frail or elderly  

• Experience working with the Medicare and Medicaid populations and within a healthcare organization 

Compensation:  

We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, paid parental leave (birthing and non-birthing parents), short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $67,100 - $76,960. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. 

Vaccination Policy, including COVID-19 

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as and essential requirement of this role.  Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment. 

Our Commitment to Diversity, Equity, and Inclusion: 

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. 

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law.  Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at [email protected]. 

Beware of Scams and Fraud 

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/.