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Eligibility Specialist

4 months ago

Salem, United States Northwest Senior And Disability Services Full time

General Description Meets Agency Mission, Vision and Values by determining financial eligibility for benefits and enrolling consumers, and ongoing maintaining of consumer enrollment in various medical assistance programs. Essential Functions Determine eligibility for participation in financial, medical, and SNAP benefits Conduct annual reviews of financial eligibility for participation in financial, medical, and SNAP benefit programs Provides ongoing consumer maintenance Provides additional assistance to consumers as needed Protects consumers and reduces Agency risk Provides excellent service in a professional manner 1. Determine eligibility for participation in financial, medical, and SNAP benefit programs by: Interview individuals via phone or in person to gather necessary information. Explain benefits and resources available. Review application document for completeness (may include helping individual through application process). Assist applicant in obtaining verifications. Collaborate and coordinate with others including Department of Human Services, Oregon Health Authority, Coordinated Care Organizations, attorneys, behavioral health partners, pharmacies, Social Security Administration, Medicare, medical providers, etc. Process forms and documents. Apply program rules and policy to determine if individual qualifies for programs. Provide notification of eligibility decisions timely and completely as outlined in rules and policy. Maintain electronic and paper consumer files. Cover incoming calls on eligibility for unit, i.e. "Worker of the Day." 2. Conduct annual reviews of financial eligibility for participation in financial, medical, and SNAP benefit programs Ensure consumer receives re-determination information. Review returned materials for completeness. Contact consumer for additional information or to clarify as necessary. Apply program rules and policy to determine if individual continues to qualify for program. Provide notification of eligibility decisions timely and completely as outlined in rules and policy. Maintain electronic and paper consumer files. Process information, forms, and documents between determinations to ensure consumer benefits are current. Receive, review, and process updated information from consumers. Adjust benefits as needed. Verify information. 4. Provide additional assistance to consumers as needed Process and review forms and data related to MMIS database. Provide additional resources and community referrals as appropriate. Attend consumer hearings and providing testimony as necessary. Process other reports as necessary, such as reporting deceased consumers, monthly reports to manager on closed, denied, and withdrawn cases. Communicate with individuals whose primary language skills are non-English. Provide services to consumers whose primary language skills are non-English. Serve as an interpreter for the Agency in identified language pair, including oral and written, interpret and explain forms, explain rules and policies, etc. Translation of written materials. 5. Promote person-centered services Embrace and exhibit the Agency Mission and Core Values. Understand the role of consumer choice. Interact with the public, consumers, co-workers, and others in a patient, respectful, and culturally appropriate manner. Educate self and others of resources available for populations served, including researching electronic and written materials and Aging and Disability Resource Connection of Oregon resource database. Understand other Agency resources and accessing resources and assistance to consumers as needed 6. Protects consumers and reduces Agency risk Follow policies, regulations, and requirements of the project and Agency; document plan and progress as required. Serve as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation. Maintain and sharing information according to privacy regulations. 7. Provides excellent service in a professional manner Meet the needs of consumers, follow through, meeting deadlines, and maintain skills and knowledge to perform the job. Apply the required knowledge and skills and exhibit critical thinking and problem-solving. Exhibit good decision-making, problem-solving, and work habits. Meet quality standards in accuracy, judgment, timeliness, and following policy and procedure. Exhibit good work habits, including organizational skills, regular attendance, working independently, seeking and offering assistance when needed. Exhibit technology skills related to the work needing to be done, (word processing, spreadsheets, database, internet research, mail, IM, phones, copiers, assessment programs like as CAPS, Oregon ACCESS, etc.); Regular attendance to meet the demands of this job and provide necessary services. Experience and Skills:

Minimum Qualifications - Education and Experience Bachelor’s degree in social sciences or any related field Work or volunteer experience working directly with consumers in social service type settings. Experience can be substituted for education. Any combination of related education and relevant work experience equaling at least 4 years. Successful completion of a Language Proficiency Test Knowledge, Skills, and Abilities The successful applicant must have the following general skills, including the ability to: Understand and interpret applicable policies and apply them to problem-solving and decision-making in order to serve external and internal customers Apply the knowledge and skills in a timely, accurate, and efficient manner to meet deadlines Process a high volume of work with critical deadlines Organize and prioritize work to meet required timeframes Multi-task Collaborate and coordinate with others Build relationships and network Exhibit excellent interpersonal communication and listening skills Exhibit good judgment, and use courtesy and tact Speak, read, write, and understand English Follow verbal and written instruction Know and commit to abide by rules governing consumer confidentiality and mandatory reporting The successful applicant must have the following job-specific skills, including the ability to: Learn available services of Agency and other community services Apply knowledge of program rules Interview and obtain general and financial information Understand the role of the individual’s preferences in care success Keep up with fast-changing rules through training and resources provided by the Agency Learn and use the database to maintain complete and timely files, including data entry and narration of ongoing work Meet quality work standards Learn and apply general office practices such as confidentiality rules, employee records maintenance, client records maintenance, and agency policies and procedures applicable to the specific program and area of work Use extensive business-English skills (grammar, spelling, and punctuation) Operate a personal computer, copier, fax machine, phone, and general office equipment, etc. (For Bilingual) Successfully demonstrate the required level of oral and written proficiency for bilingual duties in identified language pair (English/Spanish, Russian, ASL, etc.) Other Requirements Support the agency’s mission, ethics, and values Secure and maintain a valid driver’s license in the state of Oregon, or an acceptable alternative means of transportation Commit to regular attendance as it is required to meet the demands of this job Pass a criminal background check successfully Maintain and share information according to privacy regulations Serve as a mandatory reporter of suspected abuse of vulnerable populations as required by policy and regulation Complete necessary work as assigned WORK ENVIRONMENT/PHYSICAL DEMANDS This is a fast-paced, deadline-driven position where accuracy, efficiency, and excellent customer services are essential. Frequent consumer contact, high volume detailed work. This job is performed primarily in the office with possible occasional work in the field. Office work

will be conducted using general office equipment, includes substantial sitting and is performed primarily in a cubicle environment, with noise and interruptions, being on phones and working at a computer.

Field work

requires travel to clients in a variety of settings, homes, facilities, etc. of varying levels of cleanliness and repair. Field work requires driving an Agency car or employee car, carrying and using a laptop computer. These essential outcomes require regular sitting, talking, hearing, computer use; frequently required to use repetitive hand motion, handle or feel, and to stand, walk, reach, bend or lift up to 25 pounds. Contact with the public in home or office environments may risk exposure to irrational/hostile behavior, contagious diseases, or contact with domestic animals. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Classification: Eligibility Specialist Bilingual Eligibility Specialist Position Number: 401 Salary Range: R19 FLSA Status: Non-Exempt Unit: Service - ES Unit 1 Location: Salem Reports to: Services Manager Union Status: Represented Last revision: May 2018 This job description is a general guide for the job to be performed and does not cover everything. Employees may be required to perform other duties, including covering for, and in, other offices. Employees are expected to follow and perform other job-related duties requested by their manager. Reasonable accommodations will be made as needed. Job descriptions are subject to change.

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