[Hiring] Medicare Eligibility Specialist @WelbeHealth

Role Description

The Eligibility Specialist is accountable for proactively addressing complex eligibility challenges and ensuring seamless participant coverage. This role works directly with CMS, DHCS, and county Medicaid offices to troubleshoot eligibility issues, correct misalignments, and advocate for participants’ eligibility for the PACE program. This role also plays a key part in training internal teams, including Outreach & Enrollment and Social Work teams, to enhance organizational knowledge and prevent eligibility-related disruptions.

This role is different because the Eligibility Specialist at WelbeHealth:

• Plays a critical role in securing life-sustaining coverage for vulnerable seniors, working hand-in-hand with Medi-Cal, Medicare, and Social Security agencies to remove barriers so participants can access comprehensive PACE services without interruption.
• Operates at the intersection of outreach, enrollment, eligibility, and revenue cycle, giving this role broader visibility and impact than traditional eligibility positions, and directly influencing program access and participant experience.

On the day-to-day, you will:

• Act as an organizational expert in Medicare or Medicaid eligibility policies and keep teams informed of regulatory updates.
• Provide guidance to leadership, internal teams, and stakeholders on eligibility cases, processes, and compliance requirements.
• Oversee resolution of complex eligibility issues, including coverage misalignments, retroactive enrollments, reinstatements, and eligibility corrections.
• Work directly with CMS, DHCS, and county agencies to troubleshoot eligibility discrepancies and secure accurate benefit assignments.
• Advocate for participants in disputed eligibility cases to minimize gaps in coverage.
• Develop and deliver training programs for internal teams to improve eligibility accuracy and efficiency, as well as maintain knowledge repositories, job aids, and process documentation to support staff in handling eligibility cases.
• Monitor and analyze enrollment and eligibility data (e.g., DTRR, 834, 820, MMR) to identify trends, discrepancies, and risks.

Qualifications

• Associate’s degree in relevant field; relevant experience may be substituted.
• Minimum of three (3) years of experience in Medicare is a must for the role.
• Minimum of one (1) year of experience working with governmental agencies.
• Excellent leadership, organizational and communication skills in settings with seniors, their families and interdisciplinary team members.
• Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects.

Requirements

• We are seeking an Eligibility Specialist that ideally has over three (3) years of experience in Medicare eligibility.
• If you’re ready to join a team that values both its participants and team members, we’d love to hear from you!

Benefits

• Medical insurance coverage (Medical, Dental, Vision).
• Work/life balance - 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days.
• 401K savings + match.
• Comprehensive compensation package including base pay and bonus.
• Additional benefits!

Compensation

Salary/Wage base range for this role is $68,640 - $77,519 / year + Bonus. Actual pay will be adjusted based on experience and other qualifications.

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment.