Senior Policy Analyst
Gold Coast Health Plan
Eligibility Coordinator – Health Plan Operations
myPlace Health
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $70,000 - $80,000 per year
Job Level
Mid-LevelSenior
Tech Stack
Go
About the role
- Champion Enrollment Success – Develop and manage seamless processes for participant Medicaid/Medi-Cal and Medicare enrollment, ensuring they maintain access to vital benefits.
- Keep Workflows on Track – Maintain accurate, real-time tracking for all eligibility and enrollment workflows across Medicare and Medi-Cal.
- Be a Pre-Enrollment Pro – Partner with LA County, IHSS, and Social Security to confirm all participant data is up-to-date, synced, and ready for enrollment.
- Own Part D Operations – Manage Part D enrollment and eligibility within Centers for Medicare & Medicaid Services systems (MARx, eRPT, COB, Transaction Facilitators), lead audits, and oversee retroactive eligibility processing.
- Drive Redetermination Efforts – Oversee California Department of Health Care Services (DHCS) redetermination data and collaborate with Social Workers to support timely renewals.
- Solve Complex Eligibility Issues – Lead troubleshooting for Part D plan operations including TROOP, PDE, and RAPS rejections.
- Deliver Personalized Support – Provide one-on-one assistance to PACE participants with warmth, care, and exceptional service.
- Guide Medicare Age-Ins – Support participants as they transition into Medicare, making the process smooth and stress-free.
- Track and Monitor with Precision – Oversee self-pay billing activities in partnership with Finance and TPA teams.
- Master the Data Game – Manage monthly enrollment reconciliations, capitation files, and vendor rosters to keep our systems aligned and accurate.
- Support Seamless Transitions – Assist enrollment and disenrollment teams with DHCS submissions, tracking, and compliance activities.
- Ensure Timely Authorizations – Monitor internal authorization workflows, ensure prompt prior authorizations, and conduct retro-reviews of unauthorized services.
- Be Audit-Ready Always – Document and support audit activities to maintain stellar health plan oversight.
- Oversee Participant Materials – Coordinate ID card requests and ensure ADA-compliant materials are delivered on time.
- Stay on Top of Regulations – Manage ongoing Part D regulatory reporting requirements with diligence and attention to detail.
- Wear Many Hats – Step in with all other duties as needed to help our mission thrive!
Requirements
- Educational Foundation – High school diploma or equivalent required.
- Heart for the Mission – A true passion for serving high-risk seniors and frail older adults.
- Local Know-How – Familiarity with Los Angeles County health coverage, services, and Los Angeles County Department of Public Social Services operations related to Medi-Cal eligibility.
- Part D Expertise – Strong knowledge of Medicare Part D enrollment processes through Centers for Medicare & Medicaid Services applications (MARx, eRPT, COB, Transaction Facilitators).
- Operational Insight – Solid understanding of health plan and provider operations and regulatory requirements (especially in PACE, Medicare Advantage, Medi-Cal, or Medi-Medi settings).
- Proven Experience – 3+ years in eligibility coordination, enrollment, or benefits management (PACE, Medi-Cal, Medicare Advantage, or Dual-Eligible experience strongly preferred).
- Adaptability – Ability to thrive in an evolving, fast-paced environment.
- Tech Savvy – Proficiency in Microsoft Excel preferred.
