Eligibility Specialist I

JOB SUMMARY

Under general supervision, determines initial and ongoing eligibility, monitors, and maintains case files for the Medicaid program, according to established criteria. May determine initial eligibility and transfer case to appropriate unit for other public assistance programs. Eligibility verification/documentation may be completed with limited contact with client and/or other tools and computes income-based budgets which may include resources. Enters information and data into required systems. Obtains and/or assists with obtaining necessary verifications and documentation. Computes budgets, prepares, and processes support documentation. Monitors and maintains case files for Medicaid program, prepares correspondence and reports, communicates with clients on an ongoing basis. Attends training as required. Provides quality customer services to clients. Performs other related duties as requested, assigned, or directed.

Benefits of Joining our Team:

• Full-Time employment with paid lunch hour
• Opportunity for Hybrid work schedule
• Pay increase after successful completion of 120-day probationary period
• Impressive benefit package that includes medical, dental, and vision
• 15 1/2 paid holidays each year
• 80 hours annually of paid vacation after one year of service
• 40 hours of personal leave each year
• Bi-Weekly accrual of sick leave up to 120 hours per year
• 14% Employer Contribution to OPERS (Ohio Public Employees Retirement System)
• Employee Wellness Program
• Flexible Spending Account (voluntary)
• Employer paid Life and Accidental Death or Dismemberment insurance
• Voluntary Short-Term and Long-Term Disability Insurance

ESSENTIAL FUNCTIONS

• Responsible for utilizing policy and procedures to screen and determine client initial and ongoing eligibility for all Medicaid programs.
• Screens all incoming applications and creates/links case in Medicaid system. Processes Medicaid cases start to finish including renewal and changes.
• Advises clients of rights and responsibilities and program requirements. Refers clients to internal and external agencies and other applicable assistance programs when necessary.
• Eligibility verification/documentation can be completed with limited contact with client and/or other resources and computes income-based budgets which may include resources necessary to determine client need.
• Processes approvals, denials, and terminations of Medicaid programs.
• Responds to and processes case changes.
• Prepares and completes case journal documentation.
• Notifies clients of status changes as required.
• Notifies clients of verification needed to process application/renewal/change via State and Agency policy/procedure.
• Utilizes all available systems to assist in determining Medicaid eligibility.
• Confers with Agency staff, governmental agencies, medical providers, and Authorized Representatives to determine eligibility and evaluate support needed for clients.
• Respond to inquiries and/or problems generated from clients, medical providers, authorized representatives, program staff, and community partners.
• Ensures compliance with rules and regulations and processes referrals to Investigations if needed.
• Prepares summaries of case histories as requested and attends and participates in hearings as directed.
• Assists new workers.
• Assists in maintaining the agency workloads in the absence of other unit staff.
• Maintains working knowledge of agency policies and procedures, manual regulations, and community resources.
• Writes and answers all associated and required correspondence as needed.
• Maintains logs and other tracking documents/tools as appropriate.
• Performs other duties as are inherent in this position and/or classification assigned.
• Presents self in a professional, ethical, and culturally sensitive manner to co-workers, staff, and other agency personnel, clients, partners and the public; adheres to all policies and procedures (e.g., division, agency, county, federal and state).
• Attends meetings, conferences, workshops, seminars and training to remain current and knowledgeable.
• on agency, provider and program rules, policies, regulations, procedures and to receive information on available resources and requirements as directed; examines professional and technical publications to remain current on mandates, issues, techniques, and procedures.
• Ability to meet attendance standards as set forth in the Collective Bargaining Agreement.

MINIMUM QUALIFICATIONS

Successful completion of 30 semester hours or 45 quarter hours (or the equivalent number of hours if mixed credits) at an accredited college and/or university, and/or post-secondary educational institution. Or education, training and/or experience in an amount equal to the Minimum Qualifications as stated above.

**********************OR*********************

High school diploma or GED and two (2) years agency experience as an Economic Support Worker, or any equivalent combination of experience in the listed classifications, or any higher classification.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of: Federal, State and Local Laws; Rules and Regulations regarding Medicaid programs; Agency policy and procedures; departmental policies and procedures*; public relations/human relations, social services.

Skill in: Oral & written communication; operation of personal computer; operation of routine office equipment (telephone, copier, fax); public relations, reading and comprehension; utilization of computer applications.

Ability to: Define problems; collect, analyze, and interpret data; establish facts and draw conclusions; preforms mathematical calculations; prepare and maintain accurate documentation; follow verbal and/or written instructions; collate and classify information about data, people and things; answer routine inquiries from the public; communicate effectively; interpret technical materials; prepare meaningful reports and other documentation; develop and maintain effective working relationships with co-workers, supervisors, public officials and other community professionals, clients, and the general public; foster a team approach in the day-to day operations; uphold the highest standards of integrity for the Agency.

Job Type: Full-time

Pay: From $17.79 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

People with a criminal record are encouraged to apply

Ability to Commute:

• Toledo, OH 43623 (Preferred)

Ability to Relocate:

• Toledo, OH 43623: Relocate before starting work (Preferred)

Work Location: Hybrid remote in Toledo, OH 43623

Salary : $18