Medi-Cal Eligibility Services Coordinator

Job Description

Job Description Position Title

: Medi-Cal Eligibility Services Coordinator Department

: Admissions Reports To

: Admissions Supervisor

POSITION SUMMARY The Medi-Cal Eligibility Services Coordinator is responsible for leading TTC’s strategy to assist patients in achieving, maintaining, and re-establishing Medi-Cal coverage. This position oversees the full lifecycle of Medi-Cal eligibility from initial application and onboarding through semiannual recertification/redetermination cycles and change-of-circumstance processing. The Medi-Cal Eligibility Services Coordinator ensures all eligibility and redetermination workflows comply with state and federal mandates, this role strictly enforces TTC's compliance with DHCS Authorized Representative (AR) rules and conflict-of-interest requirements. HOURS

: 8 per Day / 5 Days per Week Benefits Package Medical Insurance Dental Insurance Vision Care Plan Life Insurance Paid Holidays Flexible Spending Account (FSA) Paid Vacation Time Sick Time 401(k) Retirement Plan Competitive wages Stability and career advancement Continuing Education Opportunities CATEGORIES OF DUTIES Medi-Cal Initial Eligibility & Continuous Coverage Management • Lead staff in screening patients for Medi-Cal eligibility and facilitating the completion and submission of the Single Streamlined Application (SSApp) via Benefits Cal and DPSS channels. • Ensure application and eligibility workflows support timely determinations, low-barrier enrollment, and compliance with applicable federal and California requirements. • Develop and maintain proactive processes to reduce administrative or procedural loss of coverage and minimize gaps in patient eligibility Recertification & Redetermination Oversight • Oversee TTC’s operational workflow for required Medi-Cal redeterminations and renewals, including applicable semiannual cycles. • Coordinate with county eligibility workers to maximize ex-parte renewals and resolve eligibility issues before coverage is interrupted. • Oversee patient completion and signing of Medi-Cal Renewal Forms (e.g., MC 210 RV) and Statement of Facts forms (SAWS 2). Ensure income, household, and activity verifications are submitted within state-mandated timeframes. • Enforce procedures following procedural discontinuances within the 90-day cure period, submitting required documentation promptly to rescind notices of action without requiring a full re-application. • Ensure required changes in income, household size, or address are reported to the Department of Public Social Services (DPSS) within statutory deadlines, establishing new 6-month renewal dates upon completion of redeterminations as specified by DHCS guidelines. 3.

Appeals, Fair Hearings & Patient Rights •Audit and respond to county Notices of Action (NOAs) regarding denials, share-of-cost changes, or discontinuances • Assist patients with State Fair Hearing requests and coordinate or provide Authorized Representative support during the appeals process, as permitted. • Promote patient understanding of eligibility decisions, appeal rights, and available options for maintaining coverage. 4.

Authorized Representative (AR) Implementation & Compliance • Enforce mandatory completion and patient signature of the Appointment of Authorized Representative form (MC 382) prior to taking official action on a case. • Oversee completion of the Authorized Representative Standard Agreement for Organizations (MC 383), designating up to three authorized TTC employees per patient file. • Enforce strict compliance with the Political Reform Act and DHCS rules by delivering written conflict-of-interest disclosures to patients prior to acting as AR, ensuring recommendations serve the patient’s best health interest rather than TTC’s financial benefit. • Ensure patients are informed of their right to modify or revoke AR representation at any time, orally or in writing. 5.

BenefitsCal Portal & Data Systems Management • Oversee secure batching and uploading of eligibility documents, MC 382, and MC 383 forms into the Community-Based Organization (CBO) BenefitsCal portal. • Enforce standard naming conventions (e.g., ClientName_DocumentType_Date) and PDF/image quality standards. Ensure digital confirmation receipts are saved in internal Electronic Health Records (EHR). • Enforce the mandatory 7-day waiting period post-portal submission before initiating status inquiries with assigned DPSS eligibility offices. 6.

Training, Data Security & Scope Boundaries • Train Admissions, Intake, and other applicable staff on Medi-Cal eligibility workflows, renewal processes, Authorized Representative requirements, and approved signature methods. • Educate staff regarding HIPAA, state privacy requirements, DHCS guidance, and appropriate handling of sensitive eligibility information. • Ensure staff do not request, access, retain, or disclose patient information outside approved workflows or business needs. • Develop consistent procedures, job aids, and quality-control practices to support accurate and compliant eligibility operations. EDUCATION • High School degree required. Bachelor’s degree in Healthcare Administration, Social Work, Public Health, or related field preferred. • Three (3) or more years of direct experience managing Medi-Cal eligibility, enrollment, and semiannual redetermination workflows within a healthcare or community based organization setting. EXPERIENCE • Strong working knowledge of federal Medicaid requirements and California Medi-Cal eligibility rules, regulations, and DHCS guidance. • Working knowledge of Authorized Representative requirements, patient rights, informed consent, privacy, and conflict-of-interest standards. • Hands-on experience with DPSS processes, BenefitsCal/CBO portal tools, SAWS-related systems, and electronic health record systems. • Strong organizational, analytical, communication, and problem-solving skills with the ability to manage deadlines and multiple eligibility workflows. • Ability to collaborate effectively with county eligibility staff, internal departments, patients, and organizational leadership. SETTING Tarzana Treatment Centers, Inc. is a non-profit corporation, which provides behavioral healthcare services, including substance use dependency. EQUAL EMPLOYMENT OPPORTUNITY Tarzana Treatment Centers, Inc. is an equal opportunity employer and does not discriminate based on race, national origin, religion, gender, sexual orientation, disability, or any other characteristic protected by federal, state, or local law. ADA REQUIREMENT Tarzana Treatment Centers, Inc. supports the Americans with Disabilities Act. Discrimination is prohibited in all aspects of employment against disabled persons, who, with reasonable accommodations, can perform the essential functions of a job.