Manager of Financial Eligibility bei LIFE Pittsburgh

Description

Position Purpose

The Manager of Financial Eligibility plays a vital leadership and operational role in securing and maintaining Medicaid eligibility for Participants of LIFE Pittsburgh. This role ensures timely approvals, supports financial sustainability, and enables Participant access to needed care — all while navigating an inconsistent and often unreliable County Assistance Office (CAO) environment.

This is a hands-on management position — the Manager is expected to directly handle a portion of financial eligibility work while also supervising and supporting one Financial Eligibility Specialist. The scope includes both pre-enrollment eligibility and post-enrollment recertification, including presumptive enrollment cases that carry financial risk for the organization.

The ideal candidate is highly detail-oriented, exceptionally organized, and capable of managing complex eligibility determinations while coaching others to do the same. This individual serves as the primary point person for financial eligibility operations, turning to the Director of Eligibility only for escalation or strategic coordination.

Key Responsibilities

Operational Oversight & Execution (Hands-On Work)

• Personally manage a caseload of financial eligibility cases, particularly complex or high-risk situations.
• Lead all activities related to Medicaid financial eligibility for both new applicants and current Participants.
• Own the recertification process for all active Participants, ensuring continuity of coverage and documentation.
• Proactively manage cases involving presumptive enrollment, whether for new applicants or recertifying Participants.
• Maintain accurate and timely records using the Medicaid Tracker, ensuring details are updated in real time.
• Respond to pending letters, denials, approvals, and appeal requests from the CAO and oversee follow-up tasks.
• Prepare and submit appeals in collaboration with the Compliance and Enrollment teams.
• Monitor timelines and caseloads to avoid lapses in eligibility or delays in CAO processing.

Liaison to External Agencies

• Serve as the primary liaison to state Medicaid representatives, including communication with designated contacts such as Donna.
• Maintain strong working relationships with the CAO to resolve application and recertification issues.
• Represent LIFE Pittsburgh in external communications or meetings related to eligibility processes and policy updates.

Staff Supervision & Team Management

• Directly supervise one Financial Eligibility Specialist, providing day-to-day guidance, support, and coaching.
• Serve as the first point of contact for all team questions related to eligibility processing.
• Coordinate efforts between pre-enrollment and post-enrollment responsibilities to ensure smooth handoffs.
• Support recruitment, onboarding, and training of future Financial Eligibility staff if the department expands.
• Contribute to performance reviews and staff development planning in collaboration with the Director of Eligibility.

Collaboration with Finance

• Work closely with the Finance Department to ensure accurate tracking of presumptive cases, financial risk, and reimbursement timing.
• Communicate changes in eligibility status that affect revenue or billing processes.
• Assist with reconciliation of Participant records and support Finance in resolving discrepancies related to eligibility.

Process Development & Continuous Improvement

• Identify workflow inefficiencies and design improvements to increase accuracy, timeliness, and standardization.
• Develop and maintain internal training materials, SOPs, and job aids related to Medicaid eligibility.
• Stay up to date on Medicaid regulations, dual-eligibility requirements, and best practices in long-term care enrollment.

Participant & Stakeholder Communication

• Support Participants and families with the eligibility process in a clear, respectful, and compassionate manner.
• Communicate complex financial or benefit-related information in a way that is easy to understand.
• Collaborate cross-functionally with Enrollment, Compliance, and Center teams to ensure full integration of eligibility workflows.

Position Expectations

This is a high-impact position that directly affects LIFE Pittsburgh’s ability to serve Participants and maintain financial viability. The Manager of Financial Eligibility must be able to think critically, act decisively, and work compassionately — all while building strong systems and supporting the staff around them. This role is for someone who is ready to lead and do — not one or the other.

Requirements

Education & Experience

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Demonstrated experience with Medicaid eligibility processes, criteria, and documentation requirements, especially in long-term care or dual-eligible contexts.
• Prior experience in a supervisory, lead worker, or team coaching role preferred.
• Experience working with elderly or vulnerable populations is a plus.

Skills & Competencies

• Exceptional organizational skills and ability to juggle competing priorities and deadlines.
• High attention to detail with strong case tracking and documentation practices.
• Strong analytical thinking and judgment when reviewing financial documentation or eligibility criteria.
• Ability to lead and supervise others while managing individual caseload.
• Excellent communication skills, including the ability to build trust with families and external agencies.
• Strong collaboration skills, particularly with Finance and Compliance partners.
• Proficient in Microsoft Office Suite and electronic case tracking tools.

Licensure and Travel

• Valid driver’s license, personal vehicle, and proof of insurance required for regular local travel.