Eligibility & Financial Determination Supervisor

Job Description

Job Description

Responsibilities

The Eligibility and Financial Determination Supervisor works to ensure standardization, best practices and compliance with State Medicaid guidelines. This person is responsible for the implementation and enforcement of the policies and procedures used by the Eligibility and Financial Determination Specialists staff for the direct purpose of obtaining and maintaining Medicaid eligibility for InnovAge clients. Adjusting and revising these procedures and policies as needed.

Quality Administration – 70%

• Provides leadership and works closely with the Eligibility and Financial Determination Specialists, conducting case reviews, answering questions, troubleshooting cases, filling in for those out on PTO or any vacant positions. Heavily involved with each Center and the Eligibility and Financial Determination Specialists in keeping up to date on the current status of the months numbers, assisting with determining if cases can enroll pending or what course of action would provide the best outcome for all involved. Vast knowledge regarding Long Term Care Medicaid so that they can offer alternatives, options and steps that can be taken to solve and remedy Medicaid issues.
• Distributing to all Centers and other InnovAge Staff the monthly enrollment numbers as we near the end of each month. Updating this list continually so that everyone is aware of the most recent approval numbers and those needing just the functional assessment.
• Tracking each month’s new enrollments along with the Eligibility and Financial Determination Specialist for their current status and with follow through up to the point of approvals and obtaining State ID’s.
• Tracking any 10 day and denial notices on new enrollments and working those to a conclusion to an approval or to a necessary disenrollment. Monitoring these to see if there are underlying themes or reasons that need to be addressed and provide training as deemed appropriate and necessary.
• Will assist the Eligibility and Financial Determination Controller with the working relationships that InnovAge has with Medical Assistance (MA) Sites. This includes policy and procedures, changes in those policy and procedures, working thru any issues that come up on a monthly basis, face to face quarterly meetings to help resolve and bring to the table any new developments and keeping the line of communication open and transparent with these MA sites.
• Will be part of the team that distributes faxes that come in to our InnovAge fax line, making sure that these are distributed timely.
• Provides leadership with assessing procedures, policies and systems; developing/implementing plans of action for quality improvement and promote standardizations, best practices and compliance.
• Keeps current updates of Federal and State rules and regulations pertaining to Medicaid eligibility and informs staff of these changes and how it affects their jobs.

Supervision – 30%

• Effectively supervises and manages direct reports and provides, by example and leadership, motivation and direction to employees of the organization.
• Carries out supervisory responsibilities in accordance with the organization’s policies and applicable state and federal employment laws
• Helps set the tone of the department to ensure morale, team work, and that the positive employment culture of the organization is maintained.
• Insures annual employee performance reviews are conducted in a timely and effective manner. Evaluates performance of employees for compliance and established policies and objectives of the organization and contributions in attaining objectives.
• Regularly schedules leadership/management, department and staff 1:1 meetings to provide leadership, development and a forum for communication to ensure coordination and collaboration in meeting organization and individual goals.
• Responsibilities include interviewing, hiring, and training employees, planning, assigning and directing work. Appraising performance, recognizing and rewarding employees; corrective disciplinary procedures and practices (under direction of supervisor and in partnership with Human Resources) addressing complaints and resolving problems.

REQUIRED

• Associates Degree from an accredited college/university
• A minimum of one (1) year hand-on experience with the Colorado Benefit Management System (CBMS)
• Minimum of (3) years of experience determining Medicaid LTC eligibility and/or assisting clients in applying for LTC Medicaid benefits and seeing it thru to approvals
• A minimum of three years’ experience in working with the frail and/or elderly population
• Strong management skills and at least two years of experience in supervising staff
• Vast and current knowledge of long term care Medicaid regulations and guidelines
• Skilled at identifying problems, auditing systems and following up with corrections and policy changes
• Skilled in project management and facilitation of work groups, quality improvement and team meetings
• Effective working relationships with County and field staff
• Experience with generating and ensuring accurate data and presenting results orally, in writing and in graphs for technical review

PREFERRED

• Bachelor’s Degree

FLSA Exemption Status: Exempt

The pay offered for the position will take into consideration the candidate’s geographic region, job-related knowledge, skills, experience, and internal equity, among other factors. InnovAge offers a comprehensive benefits package which includes medical, dental and vision insurance, short and long-term disability, life insurance and add, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company paid holidays.