Legal Eligibility Coordinator

Schuylkill; Allentown (Lehigh County); On-site; USD 42,000 - 54,000; Full time

Job summary

Lehigh Valley Health Network is seeking a Medicaid Eligibility Counselor to assist patients and families with Medicaid applications, eligibility determinations, and documentation. You will coordinate with legal representatives, government agencies, and care teams to ensure timely submissions while protecting patient confidentiality.

The role emphasizes compliance with HIPAA and state/federal regulations, requires strong communication and organizational skills, and offers a supportive environment

Qualifications

• Associates degree or equivalent experience in healthcare admin or related field.
• 2 years in healthcare financial counseling, Medicaid eligibility, patient access, or related area.
• Knowledge of Medicaid eligibility, reimbursement, and revenue cycle operations.
• Strong communication and customer service skills for sensitive situations.
• Proficiency with EMR, MS Office, and eligibility verification tools.
• Excellent organization, analytical, and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced setting.
• Understanding of HIPAA and healthcare regulations and collaboration across teams.

Responsibilities

• Outreach to patients and families to obtain Medicaid documentation.
• Educate on Medicaid eligibility requirements and deadlines.
• Collect and verify financial, legal, and personal documents.
• Prepare and track Medicaid applications for timely filing.
• Maintain detailed records of interactions and case outcomes.
• Collaborate with attorneys, social workers, and agencies to resolve issues.
• Monitor applications and follow up on outstanding requirements.
• Support reimbursement optimization through successful enrollment outcomes.
• Ensure compliance with Medicaid regulations and HIPAA.

Skills

Communication skills

Interpersonal skills

Customer service

Organizational skills

Time management

HIPAA knowledge

Education

Associates degree in Healthcare Administration / related field

Bachelor's degree preferred

Tools

EMR

Microsoft Office

Eligibility verification systems

Job description

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Responsible for assisting patients and their families with the Medicaid application and eligibility determination process. This position serves as a liaison between patients, legal representatives, government agencies, and healthcare teams to ensure all required documentation is obtained, completed, and submitted timely and accurately. The incumbent proactively follows up with patients and external stakeholders to facilitate Medicaid approvals, reduce uncompensated care, and support compliance with federal and state regulations.

Job Duties

• Conduct outreach to patients, family members, care facilities, and designated representatives to obtain documentation required for Medicaid applications.
• Guide and educate patients and families on Medicaid eligibility requirements, application processes, documentation needs, and deadlines.
• Collect, review, verify, and organize financial, legal, and personal documentation to support Medicaid eligibility determinations.
• Prepare, submit, and track Medicaid applications, ensuring accuracy, completeness, and timely filing.
• Maintain detailed records of patient interactions, application status, documentation requests, and case outcomes.
• Collaborate with patients, attorneys, social workers, case managers, financial counselors, and government agencies to resolve application issues and secure approvals.
• Monitor pending applications, proactively address deficiencies or delays, and follow up on outstanding requirements.
• Partner with organizational leadership to identify patients requiring Medicaid assistance and support reimbursement optimization through successful enrollment outcomes.
• Ensure compliance with Medicaid regulations, HIPAA requirements, and organizational policies while maintaining confidentiality and reporting on application outcomes and productivity metrics.

Minimum Qualifications

• Associate’s Degree in Healthcare Administration, Business Administration, Social Work, or related field; equivalent experience may be considered in lieu of education.
• 2 years experience in healthcare financial counseling, Medicaid eligibility, patient access, case management, revenue cycle operations, or a related healthcare field.
• Knowledge of Medicaid eligibility, application processes, healthcare reimbursement, and revenue cycle operations.
• Strong communication, interpersonal, and customer service skills, with the ability to build rapport with patients and families in sensitive situations.
• Proficiency with electronic medical records (EMR), Microsoft Office applications, and eligibility verification systems.
• Excellent organizational, analytical, and problem-solving skills, with strong attention to detail and follow-through.
• Ability to manage multiple priorities and work effectively in a fast-paced environment.
• Knowledge of HIPAA, healthcare regulations, patient financial assistance programs, and collaborative work across multidisciplinary teams with a commitment to patient advocacy and service.

Preferred Qualifications

• Bachelor’s Degree in healthcare administration, Business Administration, Social Work, or related field.
• 1 year experience working with legal teams, financial advocacy programs, or government assistance programs.

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

Work Shift:

Day Shift

Address:

515 Hamilton St

Primary Location:

Three City Center

Position Type:

Onsite

Union:

Not Applicable

Work Schedule:

Monday-Friday; 8:00a-4:30p

Department:

1004-13117 CSS-Legal