Medicaid Eligibility Specialist

2 weeks ago

San Diego, United States Mesa County Health Department Full time

Description Mesa County Department of Human Services is a forward thinking agency that has over 300 employees serving the needs of nearly 40,000 residents. From the Colorado National Monument to the thriving agricultural lands and city centers, Mesa County contains a diverse, natural landscape that provides many outdoor activities and adventures. As individuals and an organization, we value and respect humanity, honesty, balance, inclusion and teamwork. We provide a level of flexibility for staff to be able to accommodate their lives outside of the office environment. We value family and the relationships that make our lives rewarding. Our Mission: The Mission of the Mesa County Department of Human Services is to help individuals and families achieve safety,stabilization and opportunity formeaningfulemployment. Our Values: Mesa County Department of Human Services values represent our behavioral anchors for how we conduct ourselves. Simply stated, we value Humanity, Balance, Honesty, Inclusion and Teamwork JOB SUMMARY: Performs eligibility work that requires a strong working knowledge and understanding of eligibility program rules and policies and operation of the current proscribed eligibility computer program(s). Performs duties associated with initial intake and ongoing eligibility determination for Medical Assistant Programs, as described in Colorado Staff Manuals, Volumes III, IVB, and VIII through the Department of Human Services or Department of Health Care Policy and Finance. Interprets rules and regulations of all program areas. Facilitates and/or coordinates the processes and procedures necessary to provide clients with assistance. Performs calculations and accounting functions necessary to establish eligibility and to determine the necessary steps to resolve client situations. Provides referral to other community resources to assist clients. Bilingual English / Spanish is a plus. Essential Duties ESSENTIAL JOB FUNCTIONS: (The following duty statements are illustrative of the essential functions of the job and do not include other non-essential or marginal duties that may be required. Mesa County reserves the right to modify or change the duties or essential functions of this job at any time. All responsibilities may not be performed by all incumbents.) Conducts initial and ongoing program eligibility interviews and assessments by phone, face-to-face and gathers information such as income and financial resources. Determines initial and ongoing eligibility for Medical Assistance Programs as described in Colorado Staff Manuals, Volumes III, IV-B, and VIII through the Department of Human Services or Department of Health Care Policy and Finance. Determines eligibility for Expedited Food Assistance. Approves or denies applications, closes cases as necessary, and notifies clients of decisions in writing. Transfers cases to the appropriate eligibility specialist, team, or closed caseload. Assists clients in completing forms and obtaining the necessary documentation for program participation. Assesses client needs and makes referrals to other agency and community services. Screens applications to verify programs being applied for. Uses computerized systems to research current and past assistance status and history. Sets up new case files and properly categorizes household composition. Maintains a working knowledge of the current proscribed eligibility computer system. Performs data entry functions to ensure that required and relevant information is accurately entered into numerous complex data systems. Processes change forms for continued eligibility determination. As required, verifies all information through computer data banks, pay stubs, contacts with employers and banks, etc. Ensures benefit calculations made by the current proscribed eligibility computer program(s) are accurate in order to reduce/eliminate errors. Manages workload and paper flow. Processes case changes as they occur. Ensures that all case documents are filed in the electronic case file appropriately and in a timely manner. Completes required paperwork to restore benefits, provide retroactive payments, and provide supplements. Establishes and computes recoveries and restorations due as a result overpayment or underpayment; notifies fraud investigators when case information indicates that benefits may have been received based on fraudulent information. Informs recipients/applicants of rules and regulations. Explains rights and responsibilities to clients and provides referrals to non-profit agencies and other service providers to facilitate a comprehensive solution to the client's issues. Maintains a working knowledge of program rules and regulations. Receives, researches, resolves and clears information on required program reports. Processes program sanctions. Identifies the level and kind of sanction. Provides sanction notification to the client being sanctioned. Prepares cases for and attends dispute resolution conferences, appeals hearings, or other court cases in person or by telephone to represent the county and to testify to the facts of the case. Ensures documentation is detailed and clear in the case file. Provides customer service by responding toinquiriesregarding programs and services. Handles client complaints and provides needed information regarding program guidelines. Shall engage in heavy public contact via client interviews and front window coverage. May be subject to vulgar, offensive language and behaviors from the public. Based on workload, may be required to participate in mandatory overtime; such overtime may include evenings and weekends. Responsible for understanding and demonstrating proficiency in all aspects of the eligibility position including but not limited to: face-to-face client meetings on a walk-in basis, lobby/client interviews, processing of applications and redeterminations, pulling and returning calls, working mail and any other correspondence submitted by clients.

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