VA-Eligibility Specialist

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.

Ponos Care supports individuals living with complex and chronic conditions by providing personalized care pathways that integrate medical treatment, behavioral health 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. Ponos Care continues to expand nationally, delivering innovative care management and eligibility alignment solutions that improve member outcomes and support healthcare system efficiency.

Position Overview

The Eligibility Specialist serves as a key member advocate responsible for supporting access to healthcare and social service programs that improve member well‑being. This role assists members with navigating eligibility processes for healthcare and state benefit programs while coordinating access to appropriate resources that address social determinants of health. The Eligibility Specialist will interview and collaborate with members, families, providers, and community organizations to ensure individuals receive timely and appropriate support services. Acting as a single point of contact, the specialist assists with eligibility determination, benefit applications, and resource coordination throughout the continuum of care, supporting equitable access to financial assistance programs, psychosocial resources, and community‑based supports.

Core Responsibilities

• Act as liaison with members to ensure appropriate care is accessed, provide home and social assessments, and deliver member education.
• Address social determinants of health such as transportation, housing, and food access.
• Utilize organizational and community‑based resources to establish safe and effective case‑management plans.
• Collaborate, educate, and communicate with members, families, and healthcare providers.
• Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Assist members with all aspects of the eligibility determination process and coordinate with the local Department of Social Services.
• Communicate required health‑related information to all stakeholders to ensure quality, coordinated care is provided expeditiously.
• Advocate for patients and families to ensure their needs and choices are fully represented and supported by the healthcare team.
• Adhere to detailed documentation requirements in the member’s health record.
• Partner with members to educate and apply for Long‑Term Services & Support (LTSS) and SSI on their behalf, manage state applications, track eligibility, and update members on status.
• Provide member education on community and state resources, benefits, and assess eligibility for state programs including TANF, Adults/Blind Disabled (ABD), SSI, and applicable state programs.
• Interact with the Department of Human Services (DHS) for the application process.

Qualifications and Education

• High school diploma or equivalent; some college education preferred.
• Previous experience in a call center or customer service role, preferably in a healthcare setting navigating state health & human services benefits application process.
• Strong experience with Virginia state health & human services applications (Medicaid, ABD, TANF, SSI).
• Excellent verbal and written communication skills.
• Strong organizational and multitasking abilities.
• Proficiency with electronic health records (EHR) and other relevant software.
• Compassionate, patient‑focused, and committed to high‑quality service.
• Ability to work independently and as part of a team.
• Bilingual skills are a plus.