Financial Eligibility Specialist

LIFE Pittsburgh • Pittsburgh, PA

73d • Hybrid

About The Position

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).

Requirements

• Strong critical thinking and situational analysis skills.
• High attention to detail and organizational accuracy.
• Ability to manage multiple, time-sensitive cases with professionalism and urgency.
• Effective communication skills — both written and verbal — with Participants, families, and professionals.
• Working knowledge of Microsoft Office and electronic tracking systems.
• Valid driver’s license, proof of insurance, and access to a reliable vehicle are required. Local travel is frequent.
• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• 3–5 years’ experience in Medicaid eligibility, long-term care benefits, or related financial case management strongly preferred.
• Demonstrated understanding of bank statements, assets, and financial documentation required.

Responsibilities

• 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.
• 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.
• 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.
• Maintain daily updates in the Medicaid Tracker to reflect the real-time status of each case.
• Document all communications, submissions, and follow-up actions to ensure transparency and accountability.
• Support internal reporting needs through accurate and complete case data.
• Provide support and training to new team members or Enrollment Specialists on financial eligibility workflows.
• Contribute to the development and continuous improvement of Medicaid-related procedures, job aids, and training resources.
• Identify trends or recurring issues and recommend solutions to streamline processes.
• Assist with incoming calls and general department functions.
• Support a team culture aligned with LIFE Pittsburgh’s mission, values, and service philosophy.

Benefits

• 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!
• LIFE Pittsburgh also offers a comprehensive benefits package, including health insurance, retirement plan, paid time off, and professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees