Eligibility Specialist, FL PACE Centers

Brief Description

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as health plan, healthcare provider, and social center designed for older adults with complex medical needs. We have four adult day health centers that serve participants in Miami-Dade and Broward counties.

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as health plan, healthcare provider, and social center designed for older adults with complex medical needs. We have four adult day health centers that serve participants in Miami-Dade and Broward counties.

Our careers are challenging, meaningful and rewarding.

Eligibility Specialist PACE

Screens eligibility criteria for application to Medicaid program; responsible for annual recertification for Medicaid and LOC.

• Oversees eligibility process - completes all Medicaid applications for benefits, re-certifications, and files appeals for denials with Department of Children and Families
• Reviews eligibility workflow and follows up with Department of Children and Families with changes in Medicaid policies and income
• Completes 2515 form to report all dis-enrollments and relocation to Department of Children and Families
• Completes food assistance applications for current and upcoming PACE participants
• Follows up with Intake team and PACE prospects/participants on pending documents and correspondence
• Reviews all documents submitted to Department of Children and Families, collaborates with Intake specialist on enrollment process and following up with Medicaid approval
• Provides Medicaid overview training to Intake specialists and coordinators
• Completes monthly reports: upcoming re-certifications and Medicaid issues
• Submits agency forms and reviews for accuracy for forms 2613, 2515, 2505 and all requested documentation to be submitted to Department of Children and Families
• Collaborates with state and local agencies to ensure that PACE participants have continuous public assistance:
  Social Security Administration, Department of Children and Families and CARES

• Bilingual (Spanish/English) highly preferred

• High school diploma or equivalent required
• Associates Degree in Public Administration, Human Resources and Business Administration preferred.

• 3 years social services experience

• Valid Florida driver’s license and proof of auto insurance required.

• Normal working condition with adequate lighting and ventilation

• N/A

• Ensures that resident’s/patient’s rights are adhered to
• Demonstrates professionalism and accountability
• Demonstrates a caring attitude consistent with Miami Jewish EmpathicareSM toward MJH residents, patients, family members, employees, and other facility guests
• Demonstrates excellent communication skills
• Ensures confidentiality and security of patients’ medical information
• Identifies and utilizes appropriate channels of communication
• Able to speak, read and write English
• Able to think and act calmly to meet unusual occurrences of the job
• Adheres to the organization’s Mission, Vision and Values
• Participates in departmental activities, meetings and in-services and follows established guidelines
• Maintains a safe working environment

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

We believe in the power of empathy, the value of relationships and the importance of a life…