Medicaid Benefits Eligibility Specialist PACE - FT - Day - LIFE Bordentown NJ

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$58,531.20 - $85,045.69

Scheduled Weekly Hours:

40

Position Overview

ESSENTIAL FUNCTIONS

• Maintains oversight of benefit eligibility for enrolled and prospective participants to ensure timely processing of enrollment data and monitors continuity of benefits and transition to additional benefit programs as appropriate.
• Reviews and modifies administrative Medicaid system and its operational practices as necessary. Tracks Medicaid redetermination dates and assists in obtaining supporting documentation required to ensure participants remain financially eligible.
• Assists participants with the completion of Medicaid applications by interpreting and explaining state and federal rules and regulations, verifying necessary documentation, following-up on requests for additional information with multiple Boards of Social Service and eligibility dates to support the Intake and Enrollment Department. Provides necessary documentation of intake and enrollment for monthly enrollments of new participants.
• Attends weekly meetings for verification of prospective participants' Medicaid. Attends daily meetings for assistance and education on dis-enrollments, transfers from PACE to long term care and ensuring those participants are placed into MLTSS and an appropriate HMO. Attends weekly Finance meeting and assists with disenrollment of participants from Medicaid and ensures they are reenrolled and place appropriately back on PACE without gap in capitation.
• Responds to inquiries from internal departments and multiple State and County Offices regarding new enrollments and eligibility. Determines the cause of participant disenrollment from PACE for loss of financial eligibility and works to resolve enrollment status due to loss of Medicaid or SSI. Assists in the coordination of Medicaid related administrative activities.
• Requests Estate Recovery statements from the State of NJ. Explains and reviews statements with participants and their families. Educates participants on appropriate Medicaid spend down options when they are over the Medicaid resource limit, specifically with stocks, bonds, 403b, IRAs, CDs, pensions, retirement funds and annuities.
• Educates participants on the appropriate allotted cash values for life insurance policies for prospective participants and assists current participants with options when they are over the Medicaid resource threshold.
• Accompanies participants to funeral homes and assists participants with funeral planning, specifically establishing Irrevocable Burial Trusts. Mediates funeral planning between the Boards of Social Service and funeral homes for current and prospective participants. Builds and maintains relationships with multiple Boards of Social Service.
• Performs other duties as assigned.

MINIMUM REQUIREMENTS

• High school diploma or GED. Any college education preferred.
• One year of previous healthcare or medical benefits experience.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Frequent physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion
• Occasional physical demands include: Standing , Walking
• Continuous physical demands include:
• Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs.
• Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing
• Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease , Extreme Temperatures , Radiation , Uneven Surfaces or Elevations , Extreme Noise Levels , Dust/Particulate Matter

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.