Eligibility Specialist

Always Compassionate Home Care provides the highest quality of community home-based services, combined with exceptional compassion and innovation to enhance each patient’s quality of life. By bringing together several of the top home health agencies in the state, we have become one of New York’s leading providers with strategically placed offices that serve thousands of clients every day.

Title: Eligibility Specialist

Compensation: Up to $75,000

Location: Melville, NY (on site)

***The position is based on site (Mon-Fri) at our Melville, Long Island headquarters.

Description:

The Eligibility Specialist plays a critical role in helping prospective and current clients obtain and maintain eligibility for Medicaid and other healthcare entitlements required to receive home care services. This position supports clients through the application process, facilitates communication with government agencies, and ensures that all documentation is in compliance with regulatory requirements. The Eligibility Specialist also collaborates with intake and care management teams to ensure service continuity.

Responsibilities:

• Conduct outreach to new and existing home care clients to assess needs to determine eligibility and service options
• Educate clients and families about available services, insurance options (Medicare/Medicaid/private pay), and care plan logistics
• Assist clients in navigating long-term care programs, entitlements, and community-based resources
• Conduct eligibility assessments for prospective or existing home care clients via phone, in-person, or virtual contact
• Review and verify insurance, Medicaid/Medicare benefits, managed long-term care (MLTC), and other funding sources
• Work with clients, families, and referral sources to gather required documentation
• Coordinate with state and local agencies (e.g., DOH, MLTC plans) to facilitate timely authorizations and approvals
• Accurately input and maintain eligibility data in electronic medical records
• Monitor and track pending applications and re-certifications
• Collaborate with intake and staffing coordination teams to ensure seamless service initiation
• Stay up to date with changes in state/federal regulations affecting home care eligibility
• Maintain confidentiality and comply with HIPAA regulations

Requirements:

• • Bachelor's degree in healthcare, social work, or related field preferred
• Minimum 1–2 years of experience in home care, insurance, or healthcare eligibility/intake role
• Strong knowledge of Medicaid guidelines and MLTC processes
• Proficiency in EMR systems
• Excellent communication, customer service, and organizational skills
• Ability to multitask and prioritize in a fast-paced environment
• Bilingual a plus

Benefits:

• Health/Dental Insurance
• Vision Coverage
• 401K
• AFLAC
• Paid Time Off

Always Compassionate Health provides equal opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or any other non-merit based factors protected federal, state, or local law. All employment-related decisions are based solely on relevant criteria including experience and suitability.