Libertana is a revolutionary home health care agency providing families with exceptional medical and non-medical care.
Medi-Cal Eligibility Resolution Specialist
Location
California
Posted
7 hours ago
Salary
$27 - $30 / hour
Seniority
Senior
Job Description
Medi-Cal Eligibility Resolution Specialist
Libertana
• Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows • Conduct eligibility verification using state systems, EMR platforms, and insurance databases • Communicate with county eligibility workers to clarify case status and resolve pending or denied actions • Oversee and coordinate Medi-Cal redetermination submissions • Track redetermination cycles and proactively engage members • Contact members to gather required information and explain eligibility requirements • Build relationships with county Medi-Cal offices • Collaborate with internal departments including Member Services, Revenue Cycle, Clinical Teams, and Compliance • Maintain accurate, audit-ready documentation • Conduct in-person visits to county offices when necessary • Track and report eligibility trends and case outcomes • Driving will be required to county offices • Maintain confidentiality, HIPAA compliance, and knowledge of mandated reporting requirements • Uphold agency standards, policies, and procedures as outlined in the Employee Handbook • Participate in departmental meetings and trainings as required • Performs other duties as assigned
Job Requirements
- Strong knowledge of Medi-Cal eligibility and public benefit programs
- Knowledge of Medi-Cal eligibility rules and redetermination processes
- Experience in working with electronic healthcare systems, and state eligibility systems
- Familiar with Microsoft Word and Excel programs
- Strong analytical, organizational and communication skills
- Strong communication skills
- Experience in a health plan, county eligibility office or healthcare revenue cycle
- Bilingual in Spanish preferred
- Experience resolving insurance denials or appeals
- Preferably, has a bachelor's degree in healthcare, business administration or related field
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