CrawlJobs Logo

Eligibility And Financial Redetermination Representative

United States, Salem Employment contract · Job Posted May 04, 2026
Apply Position
Job Link Share

Job Description

The Eligibility & Financial Redetermination Representative is responsible for assisting participants and their families/ caretaker(s) in the annual redetermination process for Medicaid which includes the process of obtaining documentation, providing participants with resources and assisting in necessary paperwork/documentation of all necessary forms. Completes all re-determinations for InnovAge PACE participants assigned 30 days before case due date. Monitors the Medicaid aging report and works to clear aged items in a timely manner. Communicates the policies and procedures of Long Term Medicaid, Spousal Impoverishment, and Trusts to participants in a way that is easily understood by participants, families and caregiver(s). Performs home visits and/or Day Center visits to complete all Medicaid redeterminations within required time frames in a manner that is most convenient and efficient for the participant. Assists participants, families and caretaker(s) in completing necessary paperwork needed for Medicaid re-determination including collaborating with county government technicians to assess additional documentation needed. Documents work and outcomes in the Participant Tracking System Record of Contact Notes and in the department tracking model. Organizes case load and working area in an efficient manner that allows information to be accessed when not available. Completes disenrollment forms for HMO's and forward to supervisor in a timely manner. Processes participant/Intake/social worker housing forms and completes new supporting housing forms for all RV's if there is a differential in income.

Job Responsibility

  • Completes all re-determinations for InnovAge PACE participants assigned 30 days before case due date
  • Monitors the Medicaid aging report and works to clear aged items in a timely manner
  • Communicates the policies and procedures of Long Term Medicaid, Spousal Impoverishment, and Trusts to participants
  • Performs home visits and/or Day Center visits to complete all Medicaid redeterminations
  • Assists participants, families and caretaker(s) in completing necessary paperwork for Medicaid re-determination
  • Documents work and outcomes in the Participant Tracking System Record of Contact Notes
  • Organizes case load and working area
  • Completes disenrollment forms for HMO's
  • Processes participant/Intake/social worker housing forms

Requirements

  • Current knowledge of the Medicaid system/benefits in addition to community resources that are available to seniors and their families
  • High School diploma or GED required
  • Requires a valid state issued driver's license, personal transportation, good driving record and auto insurance as required by law

Nice to have

Bi-lingual

What we offer

  • medical insurance
  • dental insurance
  • vision insurance
  • short and long-term disability
  • life insurance and AD&D
  • supplemental life insurance
  • flexible spending accounts
  • 401(k) savings
  • paid time off
  • company-paid holidays

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Similar Jobs for

Eligibility And Financial Redetermination Representative

8 matching positions

Eligibility and Financial Redetermination Supervisor

The Eligibility and Financial Redetermination Supervisor provides oversite to th...
Location
Location
United States , Richmond; Charlottesville; Salem; Newport News
Salary
Salary:
60000.00 - 74000.00 USD / Year
innovage.com Logo
InnovAge
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3+ yrs hand-on with Medicaid long term care system and benefits
  • 2+ yrs supervising staff
  • Bachelors Degree
  • Requires a state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.
Job Responsibility
Job Responsibility
  • Provides leadership and assistance to the Eligibility and Financial Redetermination Team in completion of the monthly redeterminations and meeting with them on a consistent basis regarding status of their caseloads.
  • Provides leadership and assistance to the Eligibility and Financial Redetermination Team in all other aspects of their job duties. This includes oversite of SHF’s, Medicaid Mail and distribution thereof, 10 day notices and denial notices.
  • Provides guidance and offers assistance when and where necessary.
  • Heavily involved in tracking and conducting audits of redeterminations ready to be sent to the County.
  • Vast knowledge regarding Long Term Care Medicaid so that they can offer alternatives, options and steps that can be taken to solve and remedy Medicaid issues.
  • Will be part of the overarching plan to improve quality, tracking, communication, and processes in the Medicaid Department as growth and systems dictate.
  • Back up for staff on an as needed basis and delegating as necessary.
  • Keeps current on updates of Federal and State rules and regulations pertaining to Medicaid eligibility and informs Redetermination Representatives of information that affects their jobs.
  • Effectively supervises and manages direct reports and provides, by example and leadership, motivation and direction to employees of the organization.
  • Carries out supervisory responsibilities in accordance with the organization's policies and applicable state and federal employment laws.
What we offer
What we offer
  • medical/dental/vision insurance
  • short and long-term disability
  • life insurance and AD&D
  • supplemental life insurance
  • flexible spending accounts
  • 401(k) savings
  • paid time off
  • company-paid holidays
  • Fulltime
Read More
Arrow Right

Eligibility & Financial Redetermination Representative

The Eligibility & Financial Redetermination Representative is responsible for as...
Location
Location
United States , Lakewood
Salary
Salary:
21.15 - 24.33 USD / Hour
innovage.com Logo
InnovAge
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Current knowledge of the Medicaid system/benefits in addition to community resources that are available to seniors and their families
  • High School diploma or GED required
  • Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law
Job Responsibility
Job Responsibility
  • Completes all re-determinations for InnovAge PACE participants assigned 30 days before case due date
  • Monitors the Medicaid aging report and works to clear aged items in a timely manner
  • Communicates the policies and procedures of Long Term Medicaid, Spousal Impoverishment, and Trusts to participants in a way that is easily understood
  • Performs home visits and/or Day Center visits to complete all Medicaid redeterminations within required time frames
  • Assists participants, families and caretaker(s) in completing necessary paperwork needed for Medicaid re-determination including collaborating with county government technicians
  • Documents work and outcomes in the Participant Tracking System Record of Contact Notes and in the department tracking model
  • Organizes case load and working area in an efficient manner
  • Completes disenrollment forms for HMO’s and forward to supervisor in a timely manner
  • Processes participant/Intake/social worker housing forms and completes new supporting housing forms for all RV’s if there is a differential in income
What we offer
What we offer
  • medical/dental/vision insurance
  • short and long-term disability
  • life insurance and AD&D
  • supplemental life insurance
  • flexible spending accounts
  • 401(k) savings
  • paid time off
  • company-paid holidays
  • Fulltime
Read More
Arrow Right

Eligibility & Financial Determination Specialist

The Eligibility & Financial Determination Specialist works in conjunction with t...
Location
Location
United States , Denver
Salary
Salary:
55000.00 - 61000.00 USD / Year
innovage.com Logo
InnovAge
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3+ yrs total related experience
  • 1+ yr with CBMS Medicaid systems and knowledge of Medicaid system and benefits
  • High School diploma or GED
  • Requires a valid state issued driver’s license, personal transportation, good driving record and auto insurance as required by law.
Job Responsibility
Job Responsibility
  • Reviews applications from the Enrollment Representative Group and works closely with them in obtaining necessary documentation needed for Medicaid approval
  • Works as the primary contact for the enrollment representative for ongoing training and best practices
  • Tracking system in place and provided to the Medicaid Controller showing applications received and the status of each application from first submission to approvals
  • Ensures compliance with all State Medicaid Rules and Regulations with applications being submitted by Innovage to the County Agencies
  • Fulfilling this by keeping current on updates of Federal and State rules and regulations that pertain to Medicaid, Straight Medicaid, LTC, Spousal Impoverishment and Trusts, Food Stamps, Old Age Pension (OAP) and other Medicaid programs for which IGCP participants may be eligible
  • Works with Accounts Receivable and the Medicaid Controller/Analyst to track on a monthly basis Medicaid issues with IGCP participants
  • Tracking private pay clients and instrumental in obtaining a smooth transition to Medicaid eligibility
  • Ensures that all IGCP Medicaid staff acquires and maintain the necessary Medicaid knowledge needed for the position in collaboration with the Medicaid Redetermination Manager and the Medicaid Controller
  • Immediate attention to 10 day notices and denial notice or any other adverse notices of action received on new applications that were submitted to the county technicians
  • Troubleshoots difficult cases with Enrollment Representatives and Eligibility & Financial Determination Specialists
What we offer
What we offer
  • medical/dental/vision insurance
  • short and long-term disability
  • life insurance and AD&D
  • supplemental life insurance
  • flexible spending accounts
  • 401(k) savings
  • paid time off
  • company-paid holidays
  • Fulltime
Read More
Arrow Right

Early Years Trainer

Are you a Nursery Manager or Deputy Manager ready to take the next step in your ...
Location
Location
United Kingdom , Chichester
Salary
Salary:
29000.00 GBP / Year
jobs.360resourcing.co.uk Logo
360 Resourcing Solutions
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience as a Nursery Manager or Deputy Manager
  • Level 3 qualification in Early Years (or equivalent)
  • Confidence with technology and strong organisational skills
  • Level 2 (GCSE) qualification in English and maths (or a willingness to achieve this)
  • A full driving licence and access to your own vehicle for travel within your area
Job Responsibility
Job Responsibility
  • Supporting apprentices working in nurseries and other childcare settings, helping them develop their skills and confidence
  • Creating personalised learning plans to suit each apprentice’s needs, ensuring they have the tools to succeed
  • Demonstrating how functional skills like maths and English play a role in early years care
  • Building strong relationships with employers and keeping them informed about their apprentices’ progress
  • Managing administrative tasks and planning effectively using Google Suite and other systems
What we offer
What we offer
  • Tax-free bonus
  • 25 days’ holiday (plus bank holidays) and an extra day for your birthday
  • The option to buy or sell up to five extra days of leave
  • A healthcare cash plan, dental plan, employee assistance programmes, and 24/7 GP access
  • Enhanced sick pay and life insurance
  • Reimbursement for mileage and travel expenses
  • Fulltime
Read More
Arrow Right

Registered Nurse | Emergency Department | Ed | North Adelaide

Randstad Healthcare Recruitment Agency is seeking Registered Nurses to join our ...
Location
Location
Australia , Adelaide
Salary
Salary:
80.00 - 100.00 AUD / Hour
https://www.randstad.com Logo
Randstad
Expiration Date
July 10, 2026
Flip Icon
Requirements
Requirements
  • 1+ years of experience as a Registered Nurse
  • Current AHPRA Registration
  • All relevant vaccinations
  • Current working rights for Australia (please note: sponsorship is not available for these roles)
  • Current Police Check
What we offer
What we offer
  • Access to 50% of your pay right after your shift has finished
  • Pick the shifts that work for your schedule via the myrandstad app
  • Exclusive discounts on homeloans, health insurance, plus savings at over 50 stores including Myer, Amazon and Woolworths
  • Access to our Nurse Talent Community where you have access to articles and podcasts to support your learning and development
  • Parttime
!
Read More
Arrow Right

Billing / Accounts Receivable

Location
Location
United States , Burr Ridge
Salary
Salary:
24.00 - 26.00 USD / Hour
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High school diploma required
  • Prior experience in accounts receivable, billing, collections, or a related accounting support role
  • Proficiency with Microsoft Excel, Microsoft Office, and accounting or financial software systems
  • SAP experience is a plus
  • Strong organizational skills with the ability to manage multiple account issues and deadlines effectively
  • Solid written and verbal communication skills for customer follow-up and internal coordination
  • Good math aptitude and the ability to review financial data with accuracy and attention to detail
  • Ability to analyze discrepancies, investigate supporting information, and assist with resolution of billing issues
  • Experience with construction accounting processes, including AIA billing and lien waivers, is preferred
Job Responsibility
Job Responsibility
  • Follow established accounts receivable workflows to process billing and collection activities accurately and consistently
  • Review account variances, gather supporting documentation, and research issues to determine the cause of disputed balances
  • Address improper deductions by applying internal resolution steps and coordinating next actions to clear outstanding items
  • Communicate with customers regarding overdue invoices and work toward timely payment arrangements on open receivables
  • Handle dispute resolution efforts while maintaining accuracy and confidentiality with sensitive financial information
  • Partner with teams such as order entry, finance, controllership, cash application, and billing to resolve account issues efficiently
  • Prepare and submit requests related to cancellations, credits, and invoice rebills as needed to correct customer accounts
  • Complete billing support documentation, including lien waiver and related customer billing requirements, in accordance with company procedures
What we offer
What we offer
  • Medical
  • Vision
  • Dental
  • Life and disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right

Accounts Receivable & Collections Specialist

A successful North County manufacturing company is seeking an Accounts Receivabl...
Location
Location
United States , Vista
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2+ years of AR, collections, or billing experience
  • Experience with ERP systems such as Epicor, NetSuite, SAP, or Dynamics preferred
  • Strong customer communication skills
  • Intermediate Excel skills
  • Manufacturing or distribution experience preferred
Job Responsibility
Job Responsibility
  • Apply and post customer payments
  • Reconcile customer accounts and investigate discrepancies
  • Generate aging reports and collection schedules
  • Review credit balances and account activity
  • Assist with account setup and maintenance
  • Contact customers regarding outstanding invoices
  • Resolve payment disputes professionally and efficiently
  • Maintain collection notes and account documentation
  • Partner with sales and customer service teams to resolve issues
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right

Registered Nurse | General Medical | Surgical

Randstad Healthcare Recruitment Agency is seeking Registered Nurses to join our ...
Location
Location
Australia , Adelaide
Salary
Salary:
80.00 - 100.00 AUD / Hour
https://www.randstad.com Logo
Randstad
Expiration Date
July 10, 2026
Flip Icon
Requirements
Requirements
  • 1+ years of experience as a Registered Nurse
  • Current AHPRA Registration
  • All relevant vaccinations
  • Current working rights for Australia
  • Current Police Check
What we offer
What we offer
  • Access to 50% of your pay right after your shift has finished
  • Pick the shifts that work for your schedule via the myrandstad app
  • Exclusive discounts on homeloans, health insurance, plus savings at over 50 stores including Myer, Amazon and Woolworths
  • Access to our Nurse Talent Community where you have access to articles and podcasts to support your learning and development
  • Parttime
!
Read More
Arrow Right