Eligibility and Coverage Advocate

Job Description

Job Description

This is a hybrid role with regular onsite presence required to support team and operational needs

At WelbeHealth, we're transforming the reality of senior care by providing an all-inclusive healthcare option to our most vulnerable senior population, functioning as both a care provider and care plan to those we serve.

Working as the liaison between participants and the WelbeHealth center team, the Eligibility & Coverage Advocate is responsible for assisting enrolled participants in maintaining eligibility for state and federal benefits they are intitled to such as SSI, Medicaid, and Medicare. The Eligibility & Coverage Advocate will support the Eligibility & Reconciliation (E&R) team to ensure accurate and timely resolution of eligibility issues and functions with minimal direction and prioritize daily scope of work requests, inquiries, manage turnaround times and items that need escalation. Collaborates effectively with colleagues and stakeholders to promote the WelbeHealth values, team culture and mission.

Essential Job Duties:

• Proactively identify participants coming up for Medi-Cal redetermination
• Educate and assist participants with the completion of all necessary forms, and ensure appropriate signatures are obtained
• Conduct visits to participants' homes to complete forms when necessary
• Assist with obtaining all documentation required for eligibility determination or redetermination
• Complete and file applications by initiating and maintaining proper follow-ups with participants, center staff, and government agencies to ensure timely processing and completion of all mandated applications and accompanying documentation
• Maintain a strong working relationship with the Department of Public and Social Services (DPSS) to ensure compliance with DHCS and CMS policies and procedures

Job Requirements:

• High school diploma or equivalency
• Must be comfortable working a hybrid schedule with regular onsite presence at our Modesto and Stockton Welbe Center to support team and operational needs
• Minimum of three (3) years of relevant Medi-Cal/Medicaid enrollment experience, including share of cost, spousal impoverishment protections, and appeals processes
• Experience working directly with the county DPSS submitting, managing, and appealing Medi-Cal enrollments
• Demonstrate in-depth experience with complex Medi-Cal enrollment case management, and knowledge of Medi-Cal rules, processes, and practices
• Bilingual (Spanish/English) strongly preferred
• Strong interpersonal skills, comfortable speaking to seniors in a caring manner

Benefits of Working at WelbeHealth: Apply your healthcare expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• 401k + employer match
• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• And additional benefits

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Compensation Offering

$25.61—$33.80 USD

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to View email address on ziprecruiter.com