VA-Eligibility Specialist

Job Description

Job Description

Organizational Overview

Ponos Management, Inc. is a mission-driven healthcare organization dedicated to improving outcomes for Medicaid populations through a physician-led, value-based care model. Our integrated approach addresses social, behavioral, physical, and economic barriers to care by delivering coordinated services designed to improve quality of life and reduce unnecessary hospital utilization.

Ponos Care supports individuals living with complex and chronic conditions by providing personalized care pathways that integrate medical treatment, behavioral health services, and community-based resources. Through collaboration with interdisciplinary teams, we ensure members receive holistic and continuous care that supports long-term stability and improved health outcomes.

Ponos Care continues to expand nationally, delivering innovative care management and eligibility alignment solutions that improve member outcomes and support healthcare system efficiency.

Position Overview

The Eligibility Specialist serves as a key member advocate responsible for supporting access to healthcare and social service programs that improve member well-being. This role assists members with navigating eligibility processes for healthcare and state benefit programs while coordinating access to appropriate resources that address social determinants of health.

The Eligibility Specialist will interview and collaborates with members, families, providers, and community organizations to ensure individuals receive timely and appropriate support services. This role acts as a single point of contact for members requiring assistance with eligibility determination, benefit applications, and resource coordination throughout the continuum of care.

The Eligibility Specialist plays a critical role in supporting equitable access to services including financial assistance programs, psychosocial resources, and community-based supports that improve overall health outcomes.

Core Responsibilities

• Acts as liaison role with our members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The coordinator also addresses social determinant of health such as transportation, housing, and food access.
• Utilize both organization and community-based resources to establish a safe and effective case management plan for members.
• Collaborate, education and communicate with member, family, and healthcare providers.
• Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services. Including assisting the Member with all aspects of the eligibility determination process and coordinate with the local Department of Social Services.
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team.
• Adhere to detailed, specific documentation requirements in the member’s health record.
• Works in partnership with members to educate and apply for Long-Term Services & Support (LTSS) and SSI on member behalf, manages state application, tracks eligibility and updates members appropriately in eligibility status.
• Provide member education on community and state resources, benefits and assess eligibility for state programs including TANF, Adults/Blind Disable (ABD), SSI and applicable state programs.
• Interact with Department of Human Service (DHS) for application process.

QUALIFICATIONS AND EDUCATION

• High school diploma or equivalent; some college education preferred.
• Previous experience in a call center or customer service role, preferably in a healthcare setting navigating state health & human services benefits application process.
• Strong experience in state of Virginia health & human services application process (Medicaid, ABD, TANF, SSI).
• Excellent communication skills, both verbal and written.
• Strong organizational and multitasking abilities.
• Proficient in using electronic health records (EHR) and other relevant software.
• Compassionate and patient-focused with a strong commitment to providing high-quality service.
• Ability to work independently and as part of a team
• Bilingual skills are a plus.

EEO STATEMENT

We are an Equal Opportunity Employer and are committed to fostering an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity or expression), national origin, age, disability, genetic information, veteran status, or any other protected characteristic in accordance with applicable federal, state, and local laws. We believe inclusion strengthens our organization and enhances our ability to serve members and communities nationwide. We are committed to providing reasonable accommodation for qualified individuals with disabilities throughout the recruitment and employment process.