Eligility Operations Field Specialist

4 months ago

Thomas County, United States State of Kansas Full time

Employment Benefits

Comprehensive medical, mental, dental, vision, and additional coverage Sick & Vacation leave Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave Paid State Holidays (designated by the Governor annually) Fitness Centers in select locations Employee discounts with the Retirement and deferred compensation programs

Position Summary & Responsibilities

Position Summary:

The Eligibility Operations Field Specialist (K0230792) This position will be based at the Colby DCF Office. Collaborates with the KanCare Clearinghouse and KDHE eligibility team: Assist consumers with completion of applications, collects information and routes applications, supporting documents to the Clearinghouse for timely determination of eligibility. Helps Kansas consumers embrace the online application process. Maintains current policy and program knowledge in order to authorize Medicaid benefits and answer inquiries from the general public and agencies. Analyzes, interprets, and applies numerous complex policies and regulations to the consumer’s situation. Maintains working knowledge of MMIS, KEES and relative operating systems, assists with answering consumer and agency questions, troubleshooting eligibility situations/problems; Coordinates technical documentation and reports to determine eligibility and conformance to program objectives. Tracks routing of 3160’s between assessing agencies, MCO’s, ADRCs, KDADS, and HCBS eligibility unit. Authorizes Medicaid cases in the KEES computer system for a range of Medicaid programs in a timely and accurate manner. This determination is accomplished by analyzing, interpreting, and applying numerous complex policies and regulations to the customer’s situation. Investigation of the customer’s circumstances through the use of available computer information systems, researching records provided by customers, community sources, and other sources provide the information upon which eligibility decisions are based. Utilization of fundamental accounting principles and a general understanding of legal terminology and principles is necessary in analyzing, quantifying, and applying policy.

Job Responsibilities may include but are not limited to the following:

Medical Assistance Program Coordination and Outreach: Acts as an initial liaison or client advocate resolving conflicts or misunderstanding by explaining, clarifying, and interpreting KanCare practices, procedures, and regulations; advising clients, organizations or general public about specific programs and policies. Serves as community medical assistance and expert and liaison for KDHE DHCF issues. Advises clients, organizations, and the general public about specific KanCare medical programs in an effective and understandable manner. Provides program information to consumers, agencies, community partners, educational events, Health Departments, Hospitals, Clinics. Speaks with local leaders and stakeholders regarding community health needs and establishes positive relationships with community partners. Explains and interprets KanCare operational practices, policies, procedures regulations to clients and agencies. Provides professional expertise and direction for KanCare programs. Provides direct outreach for medical assistance programs within the assigned region through a variety of strategies. Identifies and engages community partners providing information and resources regarding medical programs using a variety of strategies. Speaks to the public to provide information, explain program and changes. Establishes positive relationships with community partners. Explains and interprets program requirements and changes for consumers and community partners. Develops and implements a community outreach plan. These include, but are not limited to, organizing, and conducting outreach and educational events, participating in fairs, community events and speaking with local leaders and stakeholders regarding community health needs and barriers to medical assistance enrollment. Ensures outreach materials are located in key locations throughout community. Serves on community boards and workgroups. Collaborates with entire KDHE DHCF Eligibility Team when necessary to deliver services, including assisting at events in other regions. Activities and strategies are designed to promote medical assistance within the community and increase enrollment in these programs, understanding of program changes. Organizes and provides leadership to other community staff, including volunteers, who assist with the medical assistance application process.

Determine Eligibility For Medical Assistance Programs: Determine eligibility for all medical assistance programs (Family Medical and Elderly and Disabled). The determination is accomplished by analyzing, interpreting, and applying numerous complex policies and regulations to the consumers situation. Investigation of the customers circumstances through the use of available computer information systems, researching records provided by customer and others provide the basis for such decisions. Utilization of fundamental accounting principles and legal terminology is necessary in analyzing, quantifying, and applying policies in the customers situation. Knowledge and effective use of information systems is essential to document eligibility decisions and provide caseload management. Collaborates and coordinates with eligibility staff located at the KanCare Clearinghouse and in DCF Regional Offices as necessary.

Qualifications

Education : High School, GED Licensing & Certification: Valid Driver's License - Incumbent is required to have and maintain a valid driver's license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State. Minimum Qualifications: One year of experience in planning, implementing, monitoring activities, and determining eligibility in FMand/or E&D unit or other related Medicaid eligibility/customer service experience. Preferred Qualifications: Bachelor’s degree in liberal arts or business Word, Excel, PowerPoint, Access Proofreading, editing, attention to detail Outcome driven independent work skills Critical thinking and problem solving Customer Service Ability to apply policy Two years of experience determining Medicaid eligibility or similar income-based eligibility program

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