VA-Eligibility Specialist

Core Responsibilities

• Acts as liaison role with our members to ensure appropriate care is accessed as well as to provide home and social assessments and member education.
• Addresses social determinant of health such as transportation, housing, and food access.
• Utilizes both organization and community-based resources to establish a safe and effective case management plan for members.
• Collaborates, educates, and communicates with member, family, and healthcare providers.
• Identifies and initiates referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Includes assisting the Member with all aspects of the eligibility determination process and coordinate with the local Department of Social Services.
• Communicates with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocates for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team.
• Adheres to detailed, specific documentation requirements in the member’s health record.
• Works in partnership with members to educate and apply for Long-Term Services & Support (LTSS) and SSI on member behalf, manages state application, tracks eligibility and updates members appropriately in eligibility status.
• Provides member education on community and state resources, benefits and assess eligibility for state programs including TANF, Adults/Blind Disable (ABD), SSI and applicable state programs.
• Interacts with Department of Human Service (DHS) for application process.

Qualifications and Education

• A 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 in state of Virginia health & human services application process (Medicaid, ABD, TANF, SSI).
• Excellent communication skills, both verbal and written.
• Strong organizational and multitasking abilities.
• Proficient in using electronic health records (EHR) and other relevant software.
• Compassionate and patient-focused with a strong commitment to providing high-quality service.
• Ability to work independently and as part of a team.
• Bilingual skills are a plus.