ELIGIBILITY SUPPORT SPECIALIST

CenterLight Health System; United States; On-site; USD 55,000 - 63,000; Full time

Job summary

CenterLight Health System seeks an Eligibility Support Specialist to assist participants with Medicaid applications and renewals, ensuring accuracy and timely submission while educating participants on renewal requirements.

You will coordinate with Eligibility, Enrollment, IDT, Compliance, Business Development, Shared Services, and Site Directors to maintain compliance and improve renewal processes, generate reports, and support program growth.

Qualifications

• Associate degree or equivalent business experience (2+ years) required.
• 2+ years in healthcare industry.
• 1+ year working with older adults.
• Knowledge of Medicare, Medicaid, and PACE programs.
• Strong organizational and communication skills.
• Proficiency in Word, Excel, PowerPoint, and Outlook.

Responsibilities

• Assist participants with completing new and renewal Medicaid applications.
• Submit applications within established timelines.
• Track status and resolve issues across departments.
• Educate participants on renewal requirements and timelines.
• Collaborate with multiple departments to support renewal processes.
• Maintain accurate records of participant interactions and renewal outcomes.
• Generate reports on Medicaid renewal activity and participant satisfaction.

Skills

Healthcare experience

Older adult experience

Medicare

Medicaid

PACE

Organizational skills

Communication

Education

Associate degree or equivalent

Tools

Microsoft Office

Job description

JOB PURPOSE: 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 departments—including 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.
• 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.
• Provide education to participants regarding new and renewal of Medicaid timelines, required documentation, and program expectations.
• Collaborate 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• Experience: 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.
• 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

CenterLight Healthcare PACE, a Program of All-Inclusive Care for the Elderly, serves adults 55+ throughout New York City, Westchester, Nassau, and Western Suffolk Counties. Designed for those with Medicare and/or Medicaid, the program empowers older adults to continue to live independently at home and in their communities. CenterLight’s PACE program is one of the largest nonprofit PACE programs in the country and operates 11 PACE centers and one Alternative Care Setting (ACS) where participants can receive on-site socialization, social and personal care services, therapeutic recreation, meals, and transportation. Our PACE centers also offer medical services, rehabilitation, prescription and over-the-counter (OTC) medications to thousands of New Yorkers by an interdisciplinary team (IDT) of doctors, nurses, physical therapists, nutritionists, recreational therapists, and other professionals who work together to provide care as unique as the diverse participants enrolled in the plan. Learn more at www.CenterLightHealthcare.org. Need help creating an account? Contact HR Helpline 347-640-6108.