PACE Eligibility Supervisor

  • San Ysidro Health
  • 1601 Precision Park Lane, San Ysidro, CA, USA
  • Apr 15, 2021
Full time Health Care

Job Description

Position Summary:


Under the supervision of the Marketing & Enrollment Manager, the Eligibility Supervisor is responsible for assisting with the implementation, supervision and coordination of PACE health insurance enrollment and retention activities. Key responsibilities include direct supervision of PACE Eligibility Specialists, CMS (Centers for Medicare and Medicaid Services) and DHCS (Department of Healthcare Services) compliance with enrollment activities, ongoing education for staff, data management and reporting.


Essential Functions of the Job:


  • Ensures that San Diego PACE is compliant with CMS and DHCS PACE enrollment regulations. Creates and submits all necessary reports and requests to DHCS, CMS and SYHealth Finance Department.
  • Maintains and updates and updates departmental policies and procedures, objectives, quality assurance, safety, HIPPA regulation standards.
  • In collaboration with the PACE eligibility team, develop and implement an annual enrollment and retention plan designed to attract, enroll and retain new and existing PACE participants. This includes referral application follow-up, enrollment verification, renewal notification and assistance, case management of at-risk participants to avoid lapses in coverage and other retention strategies such as participant education activities.
  • In partnership with the Marketing & Enrollment Manager, develop and implement a San Diego PACE data collection plan to ensure accurate and timely reporting of enrollment and retention plan. Plan will include protocols, tracking and follow up on all active PACE eligibility assistance.
  • Provides education and enrollment assistance to participants/families or community groups on PACE eligibility services and PACE coverage. 
  • Assists with preparation and facilitation of department meetings or trainings and provides technical assistance as needed.
  • Interviews, trains and conducts performance evaluations of all PACE Eligibility Specialist. Performs quality assurance and continuous quality improvement activities.
  • Oversees monthly data collection and reporting activities for the eligibility team, ensuring accurate submissions: DHCS enrollment batch, SYH finance report, Apptivo, Truchart, CMS MARX entries, and all other reports as needed.
  • Represent SYH in an effective and professional manner and maintain positive working relationships with general public, participants, co-workers, management and other agencies.


Additional Duties and Responsibilities:

  • Complies with all department, organization and government policies & procedures.
  • Attends meetings and trainings as required. Participates in committees as directed.
  • Assists with translation of materials as needed.
  • Performs other related duties as assigned or requested.


Job Requirements:


Education: High School Diploma or GED equivalent required.

Preferred:  Bachelor Degree in a health or human service field.


Certifications/Licenses:  CA driver’s license with appropriate automobile insurance required. Must pass the Covered California criminal background check and PACE Marketing certification within 3 months of hiring.


Experience Required:  A minimum of 2 years in the health and human services field performing public benefit assistance (e.g. Medi-Cal, Medi-Care) administrative, case management, community research, and/or customer service experience for a public health or social service organization. Related education may substitute for experience.

Preferred: 1 year of supervisor experience.


Verbal and Written Skills to Perform the Job:  Must have excellent oral and written communication skills; organization and project management skills, Experience facilitating staff trainings and meetings.


Technical Knowledge and Skills to Perform the Job: Good knowledge of Microsoft Word applications including Excel. Computer data entry, analysis and reporting experience is required. Knowledge of electronic health data systems including NextGen, Truchart, Turbotar, and CalWin. Knowledge of Health care systems such as the Centers for Medicare and Medicaid Services and Department of Health Care Services portals. 


Competencies: Demonstrated ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service; self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines; provide prompt, efficient and responsive customer service.


Equipment Used:  Computers, iPads/tablets, phones, personal vehicle, copy machines, fax machines, and other general office equipment.


Working Conditions and Physical Requirements:  Prolonged periods of sitting while working at computer. Driving within the city. May be required to work outside normal working hours such as after hours and weekends.