Eligibility Services Representative

Eligibility Services Representative

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.

Find work/life balance:
We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.

Be a part of something bigger and make an impact:
We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.

Sharpen your skills, learn, and grow:
We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

We are looking for an ELIGIBILITY SERVICES REPRESENTATIVE who can help shape our vision and support our mission. Here is what the position will look like.

• Serves as primary eligibility resource to process Long Term Care (LTC) applications for clients by educating clients on information needed for a timely determination and by gathering income documentation, financial documentation and other necessary supporting information. Provides assistance with the application process telephonically, via mail and in person.
• Provides superior client service to clients including but not limited to eligibility requirements for verifying documentation such as bank statements, trust documents and real estate records, etc. to determine eligibility accurately.
• Conducts thorough interviews with clients to verify accuracy of information and to determine and/or rule out fraudulent documentation. Determines periods of ineligibility (POI) if any resources have been given away by the client in the past five years.
• Per the State requirements, LTC processors will work in conjunction with the state disability contractor, the Action Review Group (ARG), to determine if the client meets the Social Security Administration definition of a disability when necessary.
• Works closely with Single Entry Point agencies to begin ULTC
  100 forms for functional eligibility determination for clients requesting Long Term Care services.
• Utilizes CBMS system to enter data and process all applications to determine eligibility while holding the highest regards to accuracy, quality, security and privacy of the CBMS system.
• Processes all applications including in person, mailed in or dropped off applications in the required time frames mandated by the State contract, this includes all aspects of case updates as reported by the client and ongoing case maintenance activities.
• Utilizes resource materials, policies and procedures, handouts, databases and training opportunities to ensure accuracy and quality of all aspects of application processing.
• Meets individual performance production requirements, quality and client service standards as assigned by the department management team.
• Attends all training and participates in internal and external performance audits to ensure compliance with quality standards.
• Assists clients in a professional, ethical manner following State guidelines to ensure the privacy of Protected Health Information.
• Works with Community Providers / Facilities regarding changes or status of individual client cases when necessary. Develop relationships with Community Providers / Facilities and educate them on program rules and regulations as needed.
• Answers incoming calls with a high level of professionalism by researching, resolving client inquiries, concerns and issues. Provides accurate information to assist clients and documents the interaction in our client management system.
• Provides client service availability Monday through Friday, 8:00am to 5:00pm except for office closure and/or scheduled department training.
• Assists customers and prospective customers with Connect for Health Colorado marketplace health plan options by…