Medi-Cal Eligibility Resolution Specialist

🔥 4 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $27 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Libertana

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

👥 B2C

Healthcare Insurance • Wellness • B2C

Libertana is a home health care company dedicated to enhancing the quality of life for individuals through personalized and compassionate care. They provide a wide range of services, including skilled nursing, respite care, palliative care, and personal care for both adults and children. Libertana focuses on holistic care, ensuring that clients receive the physical, emotional, and social support they need to thrive in the comfort of their own homes, while also providing various community-based and subsidized housing services.

📋 Description

• Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows • Conduct eligibility verification using state systems, EMR platforms, and insurance databases • Communicate with county eligibility workers to clarify case status and resolve pending or denied actions • Oversee and coordinate Medi-Cal redetermination submissions • Track redetermination cycles and proactively engage members • Contact members to gather required information and explain eligibility requirements • Build relationships with county Medi-Cal offices • Collaborate with internal departments including Member Services, Revenue Cycle, Clinical Teams, and Compliance • Maintain accurate, audit-ready documentation • Conduct in-person visits to county offices when necessary • Track and report eligibility trends and case outcomes • Driving will be required to county offices • Maintain confidentiality, HIPAA compliance, and knowledge of mandated reporting requirements • Uphold agency standards, policies, and procedures as outlined in the Employee Handbook • Participate in departmental meetings and trainings as required • Performs other duties as assigned

🎯 Requirements

• Strong knowledge of Medi-Cal eligibility and public benefit programs • Knowledge of Medi-Cal eligibility rules and redetermination processes • Experience in working with electronic healthcare systems, and state eligibility systems • Familiar with Microsoft Word and Excel programs • Strong analytical, organizational and communication skills • Strong communication skills • Experience in a health plan, county eligibility office or healthcare revenue cycle • Bilingual in Spanish preferred • Experience resolving insurance denials or appeals • Preferably, has a bachelor's degree in healthcare, business administration or related field