Divisional Eligibility Support Specialist

Job Description

Job Description

Navigate Eligibility. Advocate for Residents. Protect Access to Care.
Location: Fort Worth, TX

We are seeking an experienced and highly knowledgeable Medicaid Eligibility Specialist to join our Accounts Receivable team.

This position is responsible for screening new admissions for Medicaid and disability eligibility, assisting residents and their representatives throughout the application process, and managing complex eligibility cases through resolution. The Medicaid Pending & SSI/Disability Specialist works closely with residents, families, facility Business Office Managers, Admissions teams, Eligibility team members, Area Business Office Consultants, the Lead Medicaid Pending Specialist, and government agencies.

The ideal candidate has extensive experience with Texas Medicaid eligibility, SSI and SSDI applications, long-term care admissions, and complex case advocacy. This role requires strong organization, persistence, attention to detail, and a commitment to helping elderly individuals and people with disabilities maintain access to necessary care.

Your Impact as a Medicaid Pending & SSI/Disability Specialist

In this role, you will:

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.

Manage SSI and Disability Applications

• Partner with residents and their authorized representatives to prepare and submit SSI and SSDI applications, as applicable.
• 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.

Track Cases and Complete Follow-Up

• 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.

What Makes You a Great Fit

• 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.

Benefits for Full-Time Employees

Comprehensive Coverage: Health, dental, and vision insurance

Extra Protection: AD&D, short-term disability, cancer, critical illness, and additional supplemental insurance options

Life Insurance: Whole and term life insurance policies

Professional Growth: Tuition reimbursement for continued education

Time to Recharge: Paid time off

Retirement Planning: Immediate 401(k) eligibility

Unwavering Support: Exceptional corporate resources and leadership

Equal Opportunity Employer

Creative Solutions in Healthcare is proud to be an Equal Opportunity Employer.

We are committed to fostering a diverse, inclusive, and respectful work environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other status protected under applicable law.