At WelbeHealth, we make the impossible, possible for underserved seniors. We do this through utilizing and developing cutting-edge healthcare and well-being service products especially for seniors and their families. Now is your chance to join our talented team that delivers unparalleled creative healthcare, insurance, social support and more to seniors. We create senior well-being through our courage to love, pioneering spirit and shared intention. These values permeate everything we do. At WelbeHealth, you’ll help inspire that magic by enabling our teams to push the limits of healthcare and well-being experiences and create the never-before-seen!
The Medicare Benefits Lead is responsible for assisting the Medicare Benefits Team with prospective and enrolled dual eligible participants, establish and maintain eligibility for benefits they are qualified for, such as SSI, Medi-Cal and Medicare and analyze and reconcile data to
ensure accuracy. The incumbent will assist the Manager to ensure that adherence to the Department of Health Care Services (DHCS) and Center for Medicare & Medicaid Services (CMS) Regulatory Requirements are met for the WelbeHealth program. This position will
provide oversight regarding eligibility, enrollment and reconciliation for WelbeHealth PACE participants. The Medicare Benefits Lead will collaborate effectively with colleagues and stakeholders to promote the WelbeHealth values, team culture and mission.
You’ll be responsible for:
- Lead role among nationwide WelbeHealth PACE programs as a Medicare plan resource for all WelbeHealth sites.
- Assist Medicare staff with prospective and enrolled participants in applying for benefits and resolving any eligibility issues with SSI, Medi-Cal and Medicare.
- Oversee enrollment & disenrollment transactions timely in line with CMS regulatory requirements.
- Supports enrollment and payment reconciliation through MMR & PPR data reports.
- Manage Part A and Part B applications during annual Medicare general enrollment period and age-in periods (Age 65) enabling collection of additional capitations.
- Develop positive relationships with County Medi-Cal and Social Security Administration staff, CMS and the Department of Health Care Services staff and work proactively and collaboratively to resolve eligibility challenges.
- Understand, monitor, and use State systems (e.g., POS and AEVS, MARx, WIPRO, Gentran, RPC, ERPt) effectively.
- Collaborates effectively with Finance Team to track & reconcile complex revenue collection and projections for retroactive capitation payments.
- Make recommendations on process guidelines that will assist the staff with their reconciliation reports, DTRR files, clean up files and research of eligibility issues.
- Develops materials, prepares, and coordinates data for reports.
- Ensure participant status changes are captured within the eligibility system by reconciling the Daily Transaction Reply Report (DTRR).
- Assist management staff and participate in monthly quality audits, EDV audits and
Financial and Compliance audits.
- Bachelor’s Degree in relevant field preferred.
- Valid State Driver’s License with a clean DMV record.
- Copy of recent Vehicle Insurance required.
- Minimum of three years’ experience working in an administrative Medicare support role.
- Proficiency with Microsoft Excel formulas, Word, and Outlook.
- Experience interacting with local government Medicaid, Medicare or Social Security agencies preferred.
- Good written and verbal communication skills.
- Excellent organizational, customer service and communication skills in settings with seniors, their families and interdisciplinary team members.
- Highly motivated, self-directed, able to execute tasks in a quickly changing environment and make sound decisions in emergency situations.
- Ability to work independently with minimal supervision.
- Demonstrated ability to prioritize in a fast-paced environment.
- Experience and competency working with people from diverse backgrounds and cultures.
- Bilingual English/Spanish preferred.
- Deep commitment to helping unlock the potential of our most vulnerable seniors.
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 of our employees and proof of vaccination prior to employment is required.
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. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.