Medicaid & Medicare Eligibility Coordinator

Overview

Are you an Eligibility Specialist with Medicare and Medicaid experience looking to work for an amazing organization by serving others and connecting with your co-workers?

Immanuel Pathways PACE® is seeking an Eligibility Coordinator to work at Immanuel Home Office located at 1044 North 115th Street, Omaha, NE 68154.

In this role, you will help older adults maintain access to essential healthcare benefits by managing Medicaid renewals, Medicare enrollment processes, eligibility documentation, and participant financial responsibility programs. You'll serve as a trusted resource for participants while partnering with internal teams and state agencies to ensure uninterrupted coverage and exceptional service.

Pay will be based upon experience, certifications, skills and education.

Best in Class Benefits can be found at Immanuel:

• HEALTH: Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
• LIFE INSURANCE: Employer Paid Life Insurance
• TIME OFF: Paid Time Off - accruing from day one of employment, Floating Holidays, Paid Holidays, 8 hours of Volunteer Time Off per year
• RETIREMENT: 401K with employer match
• WELLNESS: Wellness Program and Employee Assistance Program
• GROWTH AND DEVELOPMENT: Advancement opportunities (as appropriate) – we look to grow from within our organization, Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front
• Plus many more benefits!

Job Duties & Skills Required

What You Will Do

The purpose of this job is to ensure PACE participants obtain, maintain, and appropriately document Medicare and Medicaid eligibility. The Eligibility Coordinator assists participants, caregivers, authorized representatives, internal teams, and external agencies by supporting Medicaid applications and renewals, completing Medicare enrollment and disenrollment processes, resolving eligibility discrepancies, tracking payer status, and coordinating Share of Cost or Client Participation requirements in accordance with regulatory, organizational, and program requirements. 

Skills & Requirements

Education-

• Bachelor’s Degree in Business, Accounting/Finance, Marketing, Social Work or a related field is preferred.
• Equivalent combination of relevant experience may substitute for education requirement.

Experience-

• Two (2) years of experience in assisting individuals with Medicaid, Medicare, governmental benefit programs, eligibility, financial counseling, billing collection, payer coordination or other governmental programs is required.
• One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.

Other Requirements-

• Agree to abide by the philosophy, practices, and protocols of the Immanuel Pathways (PACE) organization.
• Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
• Must have a valid driver’s license, proof of insurance and have means of reliable transportation for driving to Immanuel Pathway Center locations.
• Speaking and interpreting different languages is desirable.

KEY RESPONSIBILITIES

Key (Essential) Functions of this Job

Eligibility Coordination

• Ensure participants obtain and maintain required Medicare and Medicaid eligibility.
• Monitor participant eligibility status through RTE, CMS reports received regularly, and State sites and identify issues that may affect enrollment, coverage, payment, or continued participant.
• Assist participants, caregivers, and authorized representatives with Medicaid applications, annual renewals, redeterminations, and required documentation.
• Track pending eligibility actions, deadlines, verifications, and agency requests to promote timely completion and continuity of coverage.
• Establishes and maintains relationships with state Medicaid resources.
• Maintain knowledge of current and emerging information regarding Immanuel Pathways, Federal and state regulations, and trends and disseminate and educate Immanuel Pathways managers and staff.
• Assists in developing procedures and defining and improving best practices regarding Medicaid eligibility for Immanuel Pathway Center participants. 
• Participates in monthly/quarterly meetings with State Administrating Agency and Immanuel Pathway Centers, or as needed.
• Manages all discussions with, and assists participant and authorized representative regarding Medicaid Eligibility, Miller Trust (Iowa Centers), Estate Recovery.
• Provides timely communication of Medicaid status change to Immanuel Pathway Centers, Accounting, and Risk Adjustment Analyst.

Share of Cost & Client Participation

• Manage Share of Cost, Client Participation, premium, spenddown, or related participant financial responsibility requirements as applicable.
• Communicate participant financial responsibility information clearly and respectfully to participants, caregivers, authorized representatives, and internal stakeholders.
• Coordinate with Accounting, Executive Directors, and leadership regarding outstanding balances, changes in financial responsibility, and required follow-up.

• Maintain documentation of communications, follow-up actions, balances, and resolution status.

Medicare & Medicaid Processes

• Complete monthly Medicare enrollment, disenrollment, and reconciliation processes according to established timelines.
• Enroll/disenroll Medicare covered participants through the CMS portal
• Ensure all participants maintain Medicare coverage during enrollment and if there is a discrepancy, work with participant, Social Work, and/or CMS for resolution
• Manages the monthly enrollment validation process
• Manages the monthly Medicare Entitlement process
• Works with Eligibility & Enrollment Supervisor on any enrollment/disenrollment issues.

Documentation & Reporting

• Maintain complete, accurate, and audit-ready eligibility records, reports, correspondence, and participant files.
• Enter eligibility information, status changes, and follow-up notes accurately into applicable organizational systems.
• Prepare and maintain tracking tools, spreadsheets, and reports related to eligibility status, renewals, discrepancies, and financial responsibility requirements.

• Escalate complex eligibility, payer, agency, or participant financial responsibility concerns to the appropriate leader

Compliance & Collaboration

• Adhere to applicable CMS, state Medicaid, HIPAA, participant rights, enrollment, disenrollment, and organizational requirements.
• Collaborate with Enrollment, Finance, Accounting, Operations, Executive Directors, clinical team members, and leadership to support timely and accurate eligibility outcomes.
• Protect privacy and maintain confidentiality of participant, employee, referral, payer, and organizational information.
• Identify opportunities to improve eligibility workflows, documentation accuracy, renewal timeliness, and participant experience.
• Perform other duties and special projects as assigned.

Immanuel

At Immanuel, we believe that our success is built on the collective strength of our people.  Here’s why you’ll thrive as part of our team:

•  Meaningful work: You won’t just have a job; you will have a purpose.  Our Mission impacts the lives of our residents/participants and their families, one another, and our community.
• Growth Opportunities: We invest in your development.  Whether it’s mentorship, training, or advancement, we’re committed to your growth.
• Inclusive Culture: We celebrate uniqueness and foster an environment where everyone feels valued.
• Work-Life Harmony: We believe in allowing you to thrive by leveraging your passion.  Achieve your best work while maintaining a healthy work-life harmony.
• Total Rewards: A focus on feedback and recognition, competitive compensation, a robust benefits package, and perks beyond the basics.
• Intentional Experience: We are very intentional about your employee experience, from Day One Orientation to how we onboard new managers and invest in quarterly and annual leadership training.  

 Join us at Immanuel and be a part of something extraordinary.  Your journey starts here.

• Immanuel is an Equal Opportunity Employer and participates in E-Verify.
• A background check and drug screen will be required prior to hire.
• Applicants must be currently authorized to work in the United States on a full-time basis.