Eligibility & Financial Redetermination Lead

Responsibilities

The Lead Eligibility and Financial Redetermination is responsible for providing exceptional customer service to participants and their representatives as well as timely coordination of all aspects of the redetermination process  

• Responsible for the annual redetermination processing of Medicaid which includes the process of obtaining and collecting all necessary documentation to maintain ongoing Medicaid eligibility.
• Trains new staff on the Redetermination team as well as provide support to the team in the absence of the Eligibility and Financial Redetermination Supervisor.  Other duties and training may be assigned or delegated by the Supervisor or Manager.
• Completes all re-determinations for their assigned case load on or before the required due date. Performs this task via home visit or day center visit to accommodate the participant and/or family or caregiver.
• Assists the participant/family/POA with obtaining, compiling, and collecting all necessary paperwork and documentation needed to maintain Medicaid eligibility.
• Tracks and documents all performed tasks via case notes in the participant’s record. Ensures all documents are scanned and indexed into the appropriate database. Organize caseload and working area in an efficient manner that allows information to be accessed when not available. 
• Interprets and communicates rules and regulations of Long-Term Medicaid, Spousal Impoverishment, and Trusts to participants and families/POA in a way that is easily understood. 
• Works closely with county technicians to respond to any notices or any other adverse notices of action. 
• Immediate attention to any new cases on the Aging Report and advising the supervisor of any notice of disenrollment that need to be sent out.
• Completes supportive housing forms on an as needed basis. Requests and follows through on cases that require a county transfer.
• Updates the county if a participant has moved and a county transfer is required. Follows up with the county to ensure the home address, the mailing address and the county transfer has been completed. 
• Completes disenrollment forms and submits to the county technician as required. 
• Assists with problem cases, troubleshooting and offering training and guidance. 
• Demonstrates superior time management and organization skills.
• Is the back up for Eligibility and Financial Redetermination Representatives on an as needed basis including when Representatives are behind or are out on leave.
• Demonstrates a deeper level of Long-Term Care Medicaid knowledge and shares knowledge with staff. 
• Demonstrates superior knowledge in all areas of the Medicaid Redetermination process. 
• Assists the Eligibility and Financial Redetermination Supervisor and Manager with training of staff
• Demonstrates a commitment to the quality improvement process and adheres to the philosophy of continuous improvement; identifies and responds actively and with sensitivity to the needs of all concerned; participates as a team player in all phases of the organization; and is open and responsive to change.
• Communicates and interacts in a professional manner.
• Maintains strict confidentiality of personnel data, proprietary information, and sensitive materials as required.
• Maximizes cost efficiency and productivity in the use of all resources of the department and organization.
• Attends all required department events, staff meetings, and any other job-related functions. Attends and successfully completes all mandatory trainings.
• Does not communicate with any news media or volunteer business information to other agencies. Directs public relations issues to the appropriate person.
• Does not enter any contract without approval which commits the organization to any obligation, or which transfers company assets to any outside interests, or which involve expenditures of a capital nature.
• Performs within position and personal limitations and provides information to employees, co-workers, business contacts, and others only as able and appropriate for position.

REQUIRED

• High School diploma or GED required.
• A minimum of three years’ total experience.  Current knowledge of the Medicaid system/benefits in addition to community resources that are available to seniors and their families.
• A minimum of two years working with the frail or elderly is required.
• Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.
• Able to establish and maintain cooperative and positive working relationships.
• Organized, detail-oriented, courteous, proactive, self-motivated, dependable, and excellent customer service skills.
• Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
• Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
• A minimum of 5 years working in the Long-Term Care Medicaid Field
• Strong problem-solving skills
• Possess strong interpersonal and verbal communication skills
• Proven track record of being able to handle difficult situations with diplomacy and professionalism
• Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge. 
• Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

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.

Benefits

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

 

InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

 

Applicants are considered until the position is filled.

Posted Pay Range

$52,000-$65,000

Additional Information

Compensation Disclaimer

The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity.  InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.

 

Attention Florida ApplicantsThis position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.For more information, please visit the Clearinghouse Education and Awareness website:  https://info.flclearinghouse.com

 

Agency Disclaimer

InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.

 

Fraud Disclaimer

InnovAge is committed to maintaining a safe, transparent, and respectful hiring process for all candidates.

Please be aware that all legitimate email communication regarding InnovAge job opportunities will come exclusively from an email address ending in @innovage.com. 

At no point in our hiring process will InnovAge:

• Request payment from candidates for equipment, background checks, onboarding, training, or any other employment‑related purpose
• Ask for financial information (such as bank account details) before a formal offer and onboarding process is completed through our official systems

If you receive a message claiming to represent InnovAge that does not align with the above, it may be fraudulent. We encourage you to exercise caution and refrain from engaging or sharing personal information.

If you believe you have been contacted by someone misrepresenting InnovAge, please report the activity to [email protected] or apply directly through our official career site to ensure the opportunity is legitimate.

Your trust matters to us, and we appreciate your interest in joining InnovAge.