Benefits Specialist Ii

3 weeks ago

Jacksonville, United States Northeast Florida Area Agency Full time

**SUMMARY**

This position will work remotely most of the time. The professional staff is 100% Medicaid related and shall perform some or all of the following ADRC intake, screening and triage activities that inform eligible or potentially eligible individuals, their families, and/or the community about Medicaid covered services and how to obtain them.

**I. Essential Duties and Responsibilities**:

- Verify an individual?s current Medicaid eligibility status for purposes of the Medicaid eligibility process.
- Explain Medicaid eligibility rules and the Medicaid eligibility process to prospective applicants.
- Post information in the enrollment and termination screens of CIRTS to update the APCL as needed.
- Provide necessary forms and package all forms in preparation for Medicaid eligibility determination.
- Coordinate with these staff regarding eligibility matters for Medicaid eligible or potentially eligible individuals.
- Assist in obtaining the Physician Referral Form (3008) for Medicaid Waiver probable individuals and coordinate with CARES (Comprehensive Assessment and Review for Long Term Care Services) staff for determination of functional eligibility.
- Package all forms in preparation for Medicaid eligibility determination.
- Collect, review and maintain accurate data on individuals who are going through the Medicaid eligibility process to ensure completeness, accuracy and timeliness.
- Assist Statewide Medicaid Managed Care Long-Term Care enrollees with grievances and complaints they may have with their managed care plan, their services, their providers, or the program in general.
- Contact individuals on the Assessed Priority Consumer List (APCL) as required to update information and screen for Medicaid eligibility.
- Participate in meetings with DCF, CARES and other entities as appropriate to facilitate and enhance the Medicaid eligibility determination process.
- Act as a consumer advocate by coordinating with CARES and DCF/ACCESS staff to resolve in a timely manner any eligibility issues that arise during the Medicaid eligibility determination process
- Accept referrals from the Elder ADRC Helpline as well as other resources for intake and screening utilizing a standardized screening instrument.
- Determine the individual?s needs and screen for potential eligibility for Medicaid-related services in an efficient, timely and consumer friendly manner.
- .Input client assessments into CIRTS (Client Information and Registration Tracking System).
- Conduct comprehensive screening on Medicaid probable individuals on the Assess Priority Consumer List (APCL) who are not active in a case managed program
- Standardize and make consistent outreach efforts to ensure public awareness of Medicaid programs and services and how to access them.
- Develop, compile and distribute materials to inform individuals about the Medicaid programs as well as how and where to obtain those benefits. Note: This activity does not include compiling information already available through the Medicaid agency or Department of Elder Affairs.
- Build relationships with and educate providers, professionals and professional entities and other professionals, such as hospital discharge planners and nursing home social workers, to facilitate referrals and increase awareness of Medicaid resources which serve target populations.
- Regularly meet with and train ADRC access points to increase awareness of Medicaid resources to individuals and target populations.
- Perform other Medicaid-related duties as assigned, which may include counseling disaster victims about Medicaid programs, options and the eligibility process.

**II. Qualifications**

To perform this job successfully, this position must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Medicaid staff must have the following knowledge and skill set in order to perform Medicaid functions:

- The ability to work independently and with mínimal supervision;
- Knowledge of available ADRC administered programs and available Medicaid programs;
- The ability to work with disabled adults, elders, caregivers, stakeholders, and community partners in a knowledgeable, engaged, and compassionate manner; and
- The ability to set and track personal performance goals to efficiently manage workload.

**III. Certificates, Licenses, Registrations**
- Must be certified by completing the Aging and Disability Resource Centers Long-Term Care Program Education Certification Survey.
- Must be certified by the Department as documented by the completion of the Department approved DOEA forms 701S and 701B training modules.
- Signed acknowledgement that the employee has received, read, and understands the ?Prohibited Activities?.

**IV. Education and/or Experience**

1. Have a Bachelor?s Degree fr

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