Eligibility Specialist

Job Description

Job Description

We are looking for a detail-oriented Eligibility Specialist to join our team in Port St Lucie, Florida. In this role, you will play a critical part in ensuring the accurate and timely processing of Medicaid applications, Title IV-E determinations, and other related documentation for children in out-of-home care. This position requires strong organizational skills and the ability to collaborate effectively with various stakeholders to address eligibility and insurance-related matters.

Responsibilities :

• Compile and review documentation to complete Title IV-E determinations for children entering out-of-home care.
• Enroll new Medicaid recipients in the Sunshine Child Welfare Specialty Plan.
• Refer eligible children to the Master Trust Specialist for potential Social Security benefits.
• Submit and manage Medicaid applications for children under supervision, ensuring timely processing within 48 business hours of removal.
• Monitor and ensure Title IV-E determinations remain current, completing re-determinations as needed.
• Organize, approve, and maintain pre-adoption files in collaboration with Adoption Case Managers.
• Process adoption agreements, update placements and services, and coordinate with case managers on finalizations.
• Address Medicaid billing inquiries and assist caregivers, case managers, and investigators with eligibility documentation.
• Manage new Adoption Title IV-E applications and ensure their accuracy and timely submission.
• Interface with internal systems to designate the organization as the Medicaid Payee when applicable.
• Proven experience with insurance follow-up, Medicaid eligibility, or related processes.
• Familiarity with preauthorization procedures and Medicaid application workflows.
• Proficiency in using Microsoft Excel for data organization and reporting.
• Strong understanding of Medicaid guidelines and requirements.
• Excellent organizational skills with the ability to manage multiple priorities effectively.
• Strong communication and interpersonal skills to work with diverse stakeholders.
• Detail-oriented mindset to ensure accuracy in documentation and determinations.