Eligibility & Coverage Advocate

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 La Quinta 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