Medicare Eligibility Specialist
W
WelbeHealthHealthcare
Remote, USAFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of three (3) years of experience in Medicare is a must for the role Minimum of one (1) year of experience working with governmental agencies over three (3) years of experience in Medicare eligibility
Requirements
- Associate’s degree in relevant field; relevant experience may be substituted
- Minimum of three (3) years of experience in Medicare
- Minimum of one (1) year of experience working with governmental agencies
- Excellent leadership, organizational and communication skills in settings with seniors, their families and interdisciplinary team members
- Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects
- Over three (3) years of experience in Medicare eligibility
Responsibilities
- Act as an organizational expert in Medicare or Medicaid eligibility policies and keep teams informed of regulatory updates
- Provide guidance to leadership, internal teams, and stakeholders on eligibility cases, processes, and compliance requirements
- Oversee resolution of complex eligibility issues, including coverage misalignments, retroactive enrollments, reinstatements, and eligibility corrections
- Work directly with CMS, DHCS, and county agencies to troubleshoot eligibility discrepancies and secure accurate benefit assignments
- Advocate for participants in disputed eligibility cases to minimize gaps in coverage
- Develop and deliver training programs for internal teams to improve eligibility accuracy and efficiency
- Maintain knowledge repositories, job aids, and process documentation to support staff in handling eligibility cases
- Monitor and analyze enrollment and eligibility data (e.g., DTRR, 834, 820, MMR) to identify trends, discrepancies, and risks
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