Eligibility Specialist

Job Description

Job Description

We are seeking a Eligibility Specialist to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Eligibility Specialist plays an essential role in ensuring that individuals and families receive the appropriate health care and social care benefits by accurately determining their eligibility for Medicaid. The Eligibility Specialist requires a thorough knowledge of medical insurance policies and social services regulations to verify documentation effectively. The Eligibility Specialist will collaborate with applicants, healthcare providers, and government agencies to facilitate timely and accurate benefit determinations. By maintaining detailed records, the Eligibility Specialist helps to uphold program integrity and compliance with federal and state guidelines. Ultimately, The Eligibility Specialist contributes to improving access to essential health and social care services for vulnerable populations.

Minimum Qualifications:

• High school diploma or equivalent; associate degree or higher in a related field preferred.
• Experience working with Medicaid, or other medical insurance programs.
• Strong knowledge of social services and case management principles.
• Proficiency in data entry and medical review processes.
• Excellent communication and organizational capabilities.
• This role is hybrid, Must reside in Florida.

Preferred Qualifications:

• Bachelor’s degree in health administration, social work, or a related discipline.
• Certification in case management or eligibility determination.
• Experience with Medicaid program administration.
• Familiarity with electronic health records (EHR) and benefits management software.
• Prior experience working within government health care or social assistance agencies.
• Bilingual in English and Spanish

Responsibilities:

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.

• Review and assist with submission of applications for Medicaid for determination of eligibility.
• Conduct thorough reviews of upcoming recertifications and verify documentation to ensure compliance with program requirements.
• Maintain accurate and up-to-date data entry records related to applicant information and eligibility decisions and achieve monthly quality score standard.
• Communicate with applicants, and other internal and external stakeholders, to gather necessary information and resolve discrepancies in a timely manner
• Stay informed about changes in health care policies, insurance regulations, and social service programs to provide accurate guidance.
• Maintain established standards for schedule adherence, attendance, quality, and productivity.
• Perform other duties as assigned.