Eligibility Lead

Summary

Join WelbeHealth as an Eligibility Lead and become the organizational expert in Medicare or Medicaid eligibility policies, ensuring seamless participant coverage. You will serve as a strategic advisor to executive leadership, overseeing the resolution of complex eligibility issues and working directly with governmental agencies. This role involves advocating for participants, developing training programs for internal teams, and maintaining knowledge of eligibility processes. The ideal candidate possesses a minimum of five years of experience in Medicaid/Medicare eligibility and three years of experience working with governmental agencies. WelbeHealth offers a competitive total rewards package, including full medical, dental, and vision insurance, 17 days of PTO, 12 holidays, and 6 sick days.

Requirements

• Associate’s or bachelor’s degree in relevant field preferred; relevant professional experience may be substituted
• Minimum of five (5) years of experience in Medicaid, Medicare eligibility, or social services
• Minimum of three (3) years of experience in working with governmental agencies; experience working directly with CMS is highly desired
• 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

Responsibilities

• Act as the organizational expert in Medicare or Medicaid eligibility policies and keep teams informed of regulatory updates
• Serve as a strategic advisor to executive leadership on eligibility-related risks, trends, and policy implications, shaping organizational strategy and ensuring compliance with evolving federal and state regulations
• 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 coverage gaps
• Develop and deliver training programs for internal teams to improve eligibility accuracy and efficiency
• Maintain knowledge of repositories, job aids, and process documentation to support staff in handling eligibility cases

Benefits

• Full medical, dental, and vision insurance, beginning day one
• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401k match
• Healthcare coverage