For Referrals, Call PerformCare 877-652-7624

Presumptive Eligibility (PE) Coordinator

Job Description

This position is responsible for ensuring that all youth enrolled in the CMO have active Medicaid coverage.


  • Oversees Presumptive Eligibility (PE), New Jersey Family Care (NJFC) and Seriously Emotionally Disturbed (SED) Medicaid applications and ensures they are completed within mandated timeframes
  • Reviews Medicaid screening forms obtained by the Care Managers or Care Manager Assistants at the initial visit to assess type of eligibility for each youth enrolled in the CMO
  • Ensures families without Medicaid at enrollment are met with in one week of the initial meeting to complete the appropriate type of Medicaid based on the Medicaid eligibility type
  • Collects and compiles all necessary documentation for Medicaid with the assistance of Care Managers and Care Manager Assistants
  • Oversees verification of demographic information including social security numbers and date of birth to ensure the correct youth has coverage
  • Explains the Medicaid application process to families and provides hands on assistance to support families, as needed, to ensure compliance within the application process
  • Completes outreach letters to families within agency timeframes to obtain any missing documentation
  • Develops positive and effective relationships with county and state Medicaid offices and PerformCare in order to facilitate the Medicaid process
  • Documents in Cyber Health Insurance Progress Notes any relevant information on the status of Medicaid for enrolled youth in a detailed timely manner
  • Regularly monitors unpaid claims and follows up with Finance, Chief Operating Officer, and Program Managers to ensure any Medicaid coverage issues are resolved in a timely manner
  • Reviews monthly FGA report to ensure that all youth who receive CMO services in a given month have active Medicaid coverage
  • Completes REVS or EMEVS for all newly enrolled youth to ensure Medicaid coverage
  • Meets with Chief Operating Officer biweekly for supervision
  • Attends quarterly PE Coordinator meetings to maintain an understanding of the complexities of each type of coverage. Keeps up with changes and updates to the Medicaid system. Maintains annual PE Certification
  • Assists with SSI applications as needed
  • Provides Medicaid orientation trainings to new staff and ongoing updates about Medicaid
  • Maintains child and family confidentiality when interacting with coworkers and the community. Ensures written consents are obtained prior to releasing information.
  • Maintains a comprehensive tracking system to monitor new applications, SED Medicaid applications, expiring 3560 and NJFC coverage to ensure there are no gaps in coverage. Maintains a filing system for all information related to the Medicaid eligibility process.


  • Bachelor’s Degree preferred
  • Experience with New Jersey Medicaid Systems/processes and/or Presumptive Eligibility Certification
  • Experience working with children and families preferred
  • Bilingual (Spanish/English) preferred
  • Must possess a valid NJ Driver’s license

Additional Qualifications/Attributes

  • Excellent communication and interpersonal skills
  • Good organizational skills and the ability to prioritize effectively
  • Professional, positive and enthusiastic attitude
  • Team player and able to build positive working relationships