The Medi-Cal Eligibility Specialist is responsible for identifying, resolving, and preventing Medi-Cal eligibility issues that impact residents’ access to services or hinder reimbursement. This role ensures timely coordination of Medi-Cal redeterminations, collaborates with county eligibility offices, and supports residents through complex eligibility processes. The position is primarily in office, with required field visits to county Medi-Cal offices when in-person resolution is more effective.
Responsibilities
- Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows.
- Conduct eligibility verification using state systems and Health 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 residents/residents resp party
- Contact residents/Resp Party to gather required information and explain eligibility requirements.
- Build relationships with county Medi-Cal offices.
- 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.
- Performs other duties as assigned.
QUALIFICATIONS:
- 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. (PCC preferred)
- Familiar with Microsoft Word and Excel programs.
- Strong analytical, organizational and communication skills.
- Strong communication skills.
- Experience in Managed Medical health plans, county eligibility office
RELATED EXPERIENCE
Canidates with experience in any of the following roles are encouraged to apply, as many of the skills are transferable to this position:
- Medical Eligibility Specialist
- Medical Eligibility Resolution Specialist
- Business Office Assistant - Skilled Nursing
Pay: $28.00 - $36.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
