Eligibility Specialist (Medicaid)

The Eligibility Specialist, under general supervision, performs tasks related to the determination of eligibility and providing ongoing caseload management for economic service assistance programs such as Food and Nutrition Services, Temporary Assistance to Needy Families (Work First), Childcare, Families and Children, and/or Adult Medicaid. Implements effective caseload management techniques; assesses the customer's need for services; and participates in staff and program development. Employee must exercise tact, courtesy, and good judgment in contact with county employees, outside organizations, and the general public. Employee must also establish and maintain effective relationships as necessitated by work assignments.
 

Conducts interviews (face-to-face, by telephone and/or through third party verification) with customers utilizing established interviewing techniques to determine eligibility (also uses ex parte' information to determine eligibility) for economic services assistance; follows up with customers within established guidelines.
 
Responds to inquiries from clients and citizens regarding benefits, application process, and/or program eligibility.
 
Explains public assistance program requirements and options to client/applicant.
 
Assesses customers' needs, makes appropriate referrals and coordinates services available from other programs in a timely manner; provides guidance and direction in crisis situations; appropriately defuses emotions and fosters customer readiness to use available services and pursue self-sufficiency.
 
Computes and authorizes amounts of assistance for different programs.
 
Evaluates and verifies information and assesses the validity of customer documentation; applies federal, state, and county policies and procedures within prescribed time frames with a minimal number of errors, overdue applications, and case re-determinations.
 
Coordinates with other programs to ensure proper processing.
 
Documents case findings within established timeframes accurately to reflect customer's situation and to substantiate verification of all eligibility factors; initiates and updates data in multiple computer systems accurately (Compass and NC FAST).
 
Provides information to clients/applicants regarding programs, services, eligibility requirements and outcomes.
 
Identifies cases for investigation of potential fraud and submit appropriate fraud referral documentation.
 
Completes client re-certification for eligibility.
 
Assists in local and state hearings process as necessary.
 
Maintains and updates case records and management reports using computer skills and documentation.
 
Schedules unit eligibility activities, establishes priorities and complies with deadlines using effective time management and organizational skills; participates in appropriate training sessions to enhance job performance. Establishes activities and priorities appropriately; maintains current records and management reports which reflect an accurate accounting of caseload responsibility; appropriately utilizes and applies training received;
 
Maintains proficiency in researching the on-line integrated manual, job-aides, and administrative letters with the ability to apply the policy/procedures obtained from the respective sources; requests assistance/clarification of policy that may appear to be vague or unclear.
 
Understand and apply pertinent Federal, State and local codes, laws and regulations.
 
Ability to develop and maintain cooperative and courteous relationships with division employees, staffers and managers in other divisions, representatives from organizations, and the general public so as to maintain good will toward the division and project a good division image.
 
Assists supervisor with training of peers as requested.
 
May assists with community awareness presentations to community groups.
 
May temporarily serve as a lead worker; carrying out designated responsibilities utilizing established policies and procedures as requested.
 
Performs other related duties as assigned.