LTSS Follow-Up Specialist II

Socket.dev; United States; On-site; USD 48,000 - 72,000; Full time

Job summary

Ponos Care seeks an LTSS Follow-Up Specialist II to ensure SSA and LTSS referrals progress accurately within established workflows. You will manage intake, follow-up, monitoring, and reporting to support timely access to services for members.

You will collaborate with the Alignment and Eligibility team, perform audits, and maintain data integrity while upholding confidentiality and HIPAA requirements.

Qualifications

• High School Diploma or GED required; Associate degree preferred.
• Minimum 2 years of experience in healthcare operations, administration, reporting, eligibility, or related.
• Experience with SSA, Medicaid, LTSS, managed care, or eligibility programs preferred.
• Strong Microsoft Excel and Microsoft Office skills.
• Experience with data entry, auditing, reporting, and reconciliation.

Responsibilities

• Monitor the SSA referral inbox daily, submit disability referrals to designated vendors, and maintain accurate tracking and status reports.
• Conduct timely follow-up on assigned SSA referrals, documenting outreach efforts, case status updates, approvals, denials, pending determinations, and final outcomes.
• Maintain and update LTSS tracking reports daily, ensuring accurate documentation of approvals, denials, declined services, and ineligible determinations.
• Perform routine audits of SSA and LTSS reports to identify and correct errors, resolve discrepancies, eliminate duplicate records, and ensure data integrity.
• Support leadership reporting needs through data reconciliation, report preparation, data maintenance, and response to ad hoc reporting requests.
• Identify, document, and elevate unresolved issues, operational barriers, and report discrepancies to appropriate leadership for resolution.

Skills

Attention to Detail

Quality Assurance

Data Accuracy

Organization

Time Management

Follow-Up

Accountability

Problem Solving

Communication

Collaboration

Analytical Thinking

HIPAA Compliance

Education

High School Diploma or GED

Associate degree preferred

Tools

Microsoft Excel

Microsoft Office

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.

PonosCare supports individuals living with complex and chronic conditions by providing personalized care pathways that integrate medical treatment, behavioral health services, pharmacy 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.

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

Position Overview

The LTSS Follow-Up Specialist II supports Ponos Care’s Managed Long-Term Services and Supports (MLTSS) operations by ensuring SSA and LTSS referrals progress accurately and timely through established workflows. This position manages SSA intake and referral follow-up, monitors case outcomes, maintains accurate reporting, and conducts routine auditing and reconciliation to ensure data integrity and timely case progression.

The LTSS Follow-Up Specialist II is responsible for identifying outstanding or aging referrals, resolving documentation and data discrepancies, and ensuring weekly and monthly reports accurately reflect referral status and outcomes. This role collaborates with the Alignment and Eligibility team and other internal stakeholders to strengthen operational accountability, improve reporting accuracy, and support timely access to services for members.

Through consistent follow-up, data validation, and operational oversight, the LTSS Follow-Up Specialist II contributes to Ponos Care’s commitment to improving member outcomes, reducing barriers to services, and supporting efficient MLTSS program operations.

Core Responsibilities

• Monitor the SSA referral inbox daily, submit disability referrals to designated vendors, and maintain accurate tracking and status reports.
• Conduct timely follow-up on assigned SSA referrals, documenting outreach efforts, case status updates, approvals, denials, pending determinations, and final outcomes.
• Maintain and update LTSS tracking reports daily, ensuring accurate documentation of approvals, denials, declined services, and ineligible determinations.
• Perform routine audits of SSA and LTSS reports to identify and correct errors, resolve discrepancies, eliminate duplicate records, and ensure data integrity.
• Support leadership reporting needs through data reconciliation, report preparation, data maintenance, and response to ad hoc reporting requests.
• Identify, document, and elevate unresolved issues, operational barriers, and report discrepancies to appropriate leadership for resolution.
• Ensure strict adherence to confidentiality standards, organizational policies, and all established deadlines while maintaining high levels of accuracy and accountability.
• Perform additional administrative duties as assigned.

QUALIFICATIONS AND EDUCATION

• High School Diploma or GED required; Associate degree preferred.
• Minimum 2 years of experience in healthcare operations, administration, reporting, eligibility, case management support, or related experience.
• Experience with SSA, Medicaid, LTSS, managed care, or eligibility programs preferred.
• Strong Microsoft Excel and Microsoft Office skills.
• Experience with data entry, auditing, reporting, and reconciliation.

Preferred Qualifications

• Experience with Virginia Medicaid LTSS programs.
• Knowledge of Uniform Assessment Instrument (UAI) screening processes.
• Familiarity with DSS, VDH, and LTSS care coordination workflows.

Knowledge, Skills, and Abilities

• Attention to Detail and Quality Assurance
• Data Accuracy and Integrity
• Organization and Time Management
• Follow-Up and Accountability
• Problem Solving and Issue Resolution
• Professional Communication and Collaboration
• Analytical and Critical Thinking
• Confidentiality and HIPAA Compliance
• Process Improvement and Workflow Efficiency
• Reporting and Data Reconciliation
• Case Tracking and Prioritization
• Ability to Meet Deadlines and Performance Expectations

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.