Eligibility Specialist

The Eligibility Specialist supports children entering out-of-home care by coordinating Medicaid enrollment, reviewing eligibility documentation, maintaining coverage, and assisting with adoption and benefits-related processes. This role works closely with case managers, caregivers, foster parents, investigators, and internal support teams to ensure children receive timely access to healthcare coverage and financial assistance programs.

The position requires strong documentation skills, attention to detail, knowledge of Medicaid processes, and the ability to manage multiple cases while meeting strict regulatory timelines.

### Key Responsibilities

* Complete Title IV-E eligibility reviews
* Gather and organize eligibility documentation
* Submit Medicaid applications for children entering care
* Enroll eligible children into specialty Medicaid plans
* Process eligibility renewals and redeterminations
* Support adoption-related eligibility reviews
* Process adoption Title IV-E requests
* Maintain eligibility records and case documentation
* Coordinate with adoption case managers
* Route Social Security benefit opportunities to specialists
* Respond to Medicaid billing questions
* Assist with primary care provider changes
* Update Medicaid-related systems and payee information
* Ensure compliance with program timelines and requirements

### Requirements

* Experience with Medicaid eligibility
* Insurance follow-up experience
* Benefits coordination experience
* Strong attention to detail
* Microsoft Excel proficiency
* Case management system experience
* Strong written communication skills
* Strong verbal communication skills
* Ability to manage sensitive information confidentially
* Ability to manage multiple cases simultaneously

### Preferred Qualifications

* Child welfare experience
* Public assistance program experience
* Prior authorization knowledge
* Healthcare insurance coordination experience
* Adoption assistance program experience

### Benefits

* Medical insurance
* Dental insurance
* Vision insurance
* Life insurance
* Disability insurance
* 401(k) eligibility
* Free online training through Robert Half

### Phone Level Breakdown

* Caregiver questions: Moderate
* Case manager communication: Moderate
* Medicaid issue resolution: Moderate
* Documentation processing: High
* Eligibility review work: High
* System updates: High

### Best Fit For

Candidates with experience in Medicaid eligibility, insurance verification, healthcare benefits, patient access, prior authorization, case management support, public assistance programs, child welfare services, or healthcare administration.