Financial Eligibility Specialist

Description

About LIFE Pittsburgh

LIFE Pittsburgh, a growing nonprofit organization with approximately 400 employees, is a community-based alternative to nursing home care and assisted living. Through the LIFE Pittsburgh program, frail older adults can remain in their own home and receive a coordinated plan of care that enables them to maintain their independence and enjoy a safe and active life in the community. Our health teams of geriatric physicians and nurse practitioners, nurses, social workers, rehabilitation specialists and other health care professionals assess our Participants' needs and desires, plan and approve services with them and their family or caregiver, monitor for changes and provide timely interventions. Primary care and community services are provided through our Day Health Centers and through our in-home program according to an individual Participant's needs.

What We Offer

Rich Benefits Package including Medical, Dental, and Vision

401(k) with Company Match, vested immediately.

Life Insurance

Want to further your education? We offer Tuition Reimbursement!

Paid Time Off – Grows every pay period and rolls over into new year!

FINANCIAL ELIGIBILITY SPECIALIST

At LIFE Pittsburgh, our goal is simple: help older adults stay where they feel safest and happiest—at home.

The Financial Eligibility Specialist plays a critical role in supporting LIFE Pittsburgh’s ability to serve Participants by securing and maintaining Medicaid financial eligibility. This position ensures financial eligibility throughout the Participant journey — from initial application through ongoing recertification — enabling the organization to deliver care while maintaining financial sustainability. The role requires a combination of precise documentation, high-level judgment, and strong analytical thinking.

Success depends on the ability to manage complex cases, interpret evolving financial eligibility criteria, and maintain proactive communication with Participants, caregivers, and the County Assistance Office (CAO).

LIFE Pittsburgh employs two Financial Eligibility Specialists who share the responsibilities outlined below, with a primary focus divided across the Participant journey:

· Pre-Enrollment Specialist Primarily responsible for financial eligibility during the pre-enrollment phase. Duties include gathering and analyzing financial documentation, submitting Medicaid applications, monitoring presumptive enrollment cases, and coordinating with the Enrollment team and CAO prior to official enrollment.

· Post-Enrollment & Recertification Specialist Assumes responsibility for financial eligibility upon enrollment, particularly for presumptive cases. This includes completing pending application steps, managing Medicaid follow-up, and leading the annual recertification process for all enrolled Participants.

While each Specialist has a designated focus, cross-training and flexibility are expected. Each may assist with duties in the other’s area during high-volume periods, staffing shortages, or for coverage purposes.

Essential Functions:

Medicaid Application and Recertification Management

· Lead the timely completion and submission of Medicaid applications or renewals, ensuring documentation is accurate, comprehensive, and aligned with current eligibility criteria.

· Evaluate each case for specific financial conditions or red flags that may impact eligibility.

· Assist Participants and/or their caregivers in gathering financial documents through phone, email, or in-home visits as needed.

· Manage ongoing renewals and recertifications for enrolled Participants, ensuring timely submission prior to expiration.

Presumptive Enrollment Support

· Monitor all presumptive enrollment cases for timely resolution and accurate documentation.

· Identify potential eligibility risks prior to formal enrollment, escalating concerns to leadership as appropriate.

· Ensure Medicaid applications are submitted swiftly and accurately to minimize financial risk to the organization.

Communication and Follow-Up with the CAO

· Serve as the liaison between LIFE Pittsburgh and the CAO.

· Conduct regular case status calls with CAO representatives and maintain collaborative communication.

· Respond to all CAO correspondence including pending letters, additional information requests, denials, approvals, and appeals.

· Prepare and submit appeals as needed, collaborating with the Enrollment and Compliance teams.

Case Tracking and Documentation

· Maintain daily updates in the Medicaid Tracker to reflect the real-time status of each case.

· Document all communications, submissions, and follow-up action