Divisional Eligibility Support Specialist

Navigate Eligibility

Screen New Admissions
Review financial and nonfinancial eligibility criteria, including income, resources, disability status, citizenship, and residency, to determine the appropriate benefit pathway.
Complete eligibility prescreenings for referrals and new admissions.

• Assist with Medicaid Pending and SSI/Disability applications before or immediately following admission.
• Identify potential eligibility concerns, including asset transfers, missing documentation, unclear legal representation, and other case barriers.
• Escalate identified concerns in accordance with established policies and recommend strategies that support successful case resolution.
• Partner with Business Office Managers, Admissions team members, Eligibility team members, and Area Business Office Consultants to gather required documentation at the time of admission.

Protect Access to Care

Manage SSI and Disability Applications
Assist residents under age 65 and others who require a formal disability determination.
Help patient representatives coordinate directly with the Social Security Administration throughout the application process.

• Track applications from initial filing through determination, correction, appeal, and final case closure.
• Ensure application information and supporting documentation are accurate, complete, and submitted within required timelines.
• Communicate application requirements, case status, and next steps clearly to residents, families, and facility teams.

Maintain Accurate Case Tracker

• Maintain an accurate and current case tracker for all Medicaid Pending and SSI/Disability cases.
• Document each case’s status, outstanding requirements, next action, responsible party, and target resolution date.
• Proactively follow up with the Social Security Administration and Texas Health and Human Services Commission to prevent avoidable delays, lapses, or denials.
• Monitor aging cases and promptly address missing information, documentation requests, and unresolved eligibility concerns.
• Prepare and submit corrections or appeals following adverse decisions in consultation with the Lead Medicaid Pending Specialist.
• Maintain thorough case notes and supporting documentation throughout the eligibility process.

Advocate for Complex Cases

• Lead patient-advocacy workflows for difficult, high-risk, or complex Medicaid eligibility cases.
• Serve as a dedicated point of contact for residents and families throughout the resolution process.
• Provide hands-on assistance for cases requiring additional advocacy, supporting documentation, or written explanations.
• Draft and coordinate advocacy letters and other supporting materials on behalf of residents.
• Manage additional documentation requests from the Texas Health and Human Services Commission or Social Security Administration.
• Ensure responses to government agencies are accurate, complete, and submitted promptly.
• Support plea-of-care cases through dedicated advocacy and close coordination with facility leadership, families, and payer representatives.
• Work to protect resident access to care while ensuring all eligibility requirements are appropriately addressed.

Collaborate and Report

• Provide regular case-status updates to the Lead Medicaid Pending Specialist and Vice President of Accounts Receivable.
• Report on overall caseload, case aging, application progress, unresolved barriers, and at-risk accounts.
• Participate in Accounts Receivable team meetings and provide updates regarding the Medicaid Pending pipeline and SSI/Disability performance metrics.
• Identify trends, recurring eligibility barriers, and opportunities to improve the application process.
• Support the training of Business Office Managers and Area Business Office Consultants on SSI/Disability screening criteria and documentation requirements.
• Build strong working relationships with residents, families, facility teams, corporate departments, and government agencies.

Qualifications

• Fifteen or more years of experience in Medicaid eligibility, SSI/SSDI application processing, benefits screening, or a related field preferred.
• Experience within a skilled nursing or long-term care environment strongly preferred.
• Working knowledge of Texas Health and Human Services Commission Medicaid policies and procedures.
• Strong knowledge of the Social Security Administration’s disability determination and application processes.
• Experience evaluating financial and nonfinancial eligibility criteria for long-term care admissions.
• Demonstrated ability to advocate for residents in complex or difficult Medicaid eligibility cases.
• Experience drafting advocacy letters and managing detailed government documentation requests.
• Strong organizational and case-management skills with the ability to manage a high-volume caseload.
• Ability to prioritize multiple cases, deadlines, and follow-up requirements.
• Excellent written and verbal communication skills.
• Ability to communicate professionally and compassionately with residents, families, facility teams, and government agencies.
• Proficiency with Microsoft Excel and case-management or tracking systems.
• Ability to work independently while maintaining close coordination with the Lead Medicaid Pending Specialist and other AR leaders.
• Strong attention to detail, persistence, problem-solving skills, and commitment to timely case resolution.