Entitlement Specialist

ElderServe Health is a mission-driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long-term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is predominantly dual-eligible and enrolled in Medicaid managed long-term care, Medicare-only and integrated Medicaid-Medicare plans. The CareSource and ElderServe affiliation addresses these critical long-term care needs to help members be as healthy and independent as possible.

Job Summary:

The Entitlement Specialist is responsible for ensuring that members maintain continuous Medicaid eligibility by overseeing the timely completion of Medicaid renewals, new Medicaid applications and RVI-3 conversions. The Specialist will assist members in gathering all required documentation within designated timeframes to prevent any lapse in coverage, support members in establishing Pooled Income Trusts, and perform other Medicaid-related functions as needed, including leading the resolution of eligibility issues that arise.

Essential Functions:

• Maintains and updates the list of members Medicaid eligibility dates.
• Field visits to members home to assist with the various Medicaid eligibility tasks.
• Assures completion of Medicaid recertifications for members 90-60 days prior to expiration.
• Assists members with establishing Pooled Income Trusts when necessary.
• Tracks all submitted Medicaid recertification and address any problems with the supervisor.
• Coordinates with staff, members, member families and caregivers regarding Medicaid eligibility and the process of assuring required documents are obtained within the specified time frame.
• Takes lead in resolving difficult eligibility issues.
• Submits Medicaid Relinks to HRA and other LDSS offices.
• Maintains documentation and all records of previously submitted Medicaid recertification.
• Maintains relationship with The Office of Homecare Services and next of kin to facilitate Medicaid eligibility process.
• Manages the forwarding of initial Medicaid documents to Medicaid unit at the Office of Homecare Services.
• Assists ESH's Intake Department with problematic Medicaid issues, Complete new Medicaid applications and RVI-3 (Resource Verification Indicator) conversions.
• Attends workshops and In-services to enhance knowledge of changes in Medicaid eligibility criteria.
• Participates in the publishing of monthly Medicaid expiration list.
• Tracks the progress of new applications, Recertification and conversions submitted to the Office of Homecare Services through Epaces system.
• Continually monitors E-Paces to follow-up on or identify potential eligibility issues.
• Assists the Director or designee of Social Services and the Finance department in resolving denied Medicaid claims.
• Assists in the removal of certain Medicaid restriction codes.
• Perform any other job related duties as requested.

Education and Experience:

• High School or GED required
• Associates Degree preferred
• Three (3) years of healthcare, insurance, or related industry experience to include at least two (2) years of enrollment/eligibility or similar experience required

Competencies, Knowledge and Skills:

• Ability to understand and to carry out instructions furnished in written, oral or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
• Intermediate Computer Skills.
• Effective Communication skills.
• Ability to work independently and within a team environment.
• Attention to detail.
• Familiarity of the healthcare field.
• Knowledge of Medicaid and Medicare.
• Critical listening and thinking skills.
• Proper grammar usage.
• Time management skills.
• Proper phone etiquette.
• Customer service oriented.

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated

Working Conditions:

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.
  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
  Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
  May be required to travel greater than 50% of time to perform work duties.
  Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer
  Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
• Over 50% (Mobile) Routine travel required

Compensation Range:
$47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Hourly

Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.