ELIGIBILITY SUPPORT SPECIALIST

Eligibility Support Specialist

The Eligibility Support Specialist is responsible for assisting PACE participants with the completion, processing, and submission of new and renewal of Medicaid applications. This role ensures applications meet established quality standards, provides education to participants regarding renewal requirements, and collaborates with multiple departmentsincluding Eligibility, Enrollment, IDT, Compliance, Business Development, Shared Services, and Site Directors, to support a seamless renewal process. The position also contributes to continuous improvement initiatives, participant engagement, and organizational compliance with regulatory requirements.

Essential Duties and Responsibilities:

• Application Support and Processing
  • Assist participants in completing new and renewal of Medicaid applications, ensuring accuracy, completeness, and compliance with program requirements.
  • Submit new and renewal of Medicaid applications on behalf of participants within established timelines.
  • Track application status and follow up with participants and departments to resolve outstanding issues.
• Quality Assurance and Compliance
  • Conduct detailed reviews of Medicaid applications to confirm readiness and compliance with program standards.
  • Identify and correct errors, omissions, or inconsistencies prior to submission.
  • Maintain compliance with federal, state, and organizational regulations governing eligibility and enrollment.
  • Document quality assurance findings and recommend process improvements.
• Participant Education and Engagement
  • Provide education to participants regarding new and renewal of Medicaid timelines, required documentation, and program expectations.
  • Collaborates in the development and distribution of educational materials to support participant understanding of the Medicaid renewal process.
  • Conduct outreach to participants to ensure timely submission of new and renewals if Medicaid applications to reduce lapses in coverage.
• Collaboration and Cross-Functional Support
  • Partner with Eligibility, Enrollment, IDT, Compliance, Business Development, Shared Services, and Site Directors to coordinate renewal activities.
  • Serve as a liaison between participants and internal teams to ensure effective communication and resolution of issues.
  • Participate in cross-departmental meetings to align Medicaid renewal processes with organizational goals.
• Data Management and Reporting
  • Maintain accurate records of participant interactions, Medicaid application status, and Medicaid renewal outcomes.
  • Generate reports on Medicaid renewal activity, accuracy rates, and participant satisfaction.
  • Provide data insights to leadership to support decision-making and resource allocation.
• Continuous Improvement
  • Identify opportunities to streamline the Medicaid renewal process and improve participant experience.
  • Contribute to the development of policies, procedures, and best practices related to eligibility and Medicaid renewals.
  • Support training initiatives for staff and departments involved in the Medicaid renewal process.
• Business Development Support
  • Collaborate with Business Development to ensure participant renewals align with growth and retention strategies.
  • Provide feedback on participant needs and trends to inform outreach and engagement initiatives.
• Shared Services and Site Support
  • Coordinate with Shared Services to ensure consistency in renewal processes across sites.
  • Partner with Site Directors to address site-specific challenges and ensure participant renewals are managed effectively.

Key Results Areas (KRAs)

• Participant Retention
  • Ensure timely and accurate Medicaid renewal submissions to minimize participant disenrollment and maintain program continuity.
• Regulatory Compliance
  • Achieve full compliance with federal, state, and organizational eligibility standards through rigorous quality assurance practices.
• Operational Efficiency
  • Reduce processing time and errors in Medicaid renewal applications by implementing streamlined workflows and cross-departmental coordination.
• Stakeholder Collaboration
  • Strengthening partnerships with Business Development, Shared Services, and Site Directors to align renewal processes with organizational objectives.
• Participant Experience
  • Enhance participant satisfaction by providing clear education, proactive outreach, and responsive support throughout the renewal process.
• Organizational Growth
  • Support business development initiatives by ensuring Medicaid renewals contribute to participant retention and overall program growth.

Schedule: 8:30AM 5:30PM

Weekly Hours: 40

Qualifications:

Education: Associate degree or equivalent business experience of 2 years as a minimum.

Experience:

• Minimum of two (2+) years in the healthcare industry.
• Minimum of one (1+) year of experience working with the older adults
• In-depth knowledge of government programs: Medicare, Medicaid, PACE.
• Excellent organizational and communication skills.
• Proficient with Microsoft Office software (Word, Excel, PowerPoint, and Outlook).

Competencies:

• Customer Service Orientation: Demonstrates empathy, patience, and professionalism in participant interactions.
• Analytical Skills: Reviews applications for accuracy and compliance with program standards.
• Collaboration: Works effectively with cross-functional teams to achieve renewal goals.
• Organizational Skills: Manages participant caseloads and Medicaid renewal schedules efficiently.
• Adaptability: Adjusts to evolving program requirements and organizational priorities.
• Problem-Solving: Identifies issues and develops solutions to improve the renewal process.

Physical Requirements

Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:

• Standing Duration of up to 6 hours a day.
• Sitting/Stationary Positions Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
• Bending/Squatting Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
• Sight/Visual Requirements Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
• Audio Hearing and Motor Skills (Language) Requirements Must be able to listen attentively and document information from participants, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy.
• Cognitive Ability Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max): $55,000.00 - $63,000.00

Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-