Policy and Eligibility Specialist

1 week ago


Atlanta, Georgia, United States GeorgiaGov Full time

Position Overview: The Policy and Eligibility Specialist plays a crucial role in the evaluation and enhancement of program guidelines and operational practices for the Georgia Access – State Based Exchange.

Key Responsibilities:

  1. Conducts thorough analyses of customer concerns to identify root causes and formulates innovative processes, ensuring proper documentation of modifications and newly established procedures.
  2. Regularly reviews and revises consumer eligibility criteria, verification processes, and appeals protocols for the Georgia Access division.
  3. Assists in the preparation for the annual federal programmatic audit and any additional audits as required.
  4. Evaluates metrics, Key Performance Indicators (KPIs), and relevant reports generated by the Contact Center vendor.
  5. Prepares preliminary recommendations for the Contact Center Specialist aimed at enhancing Contact Center operations, including metrics and KPIs; develops necessary reports or dashboards.
  6. Drafts, assesses, and updates consumer support materials for the Contact Center, including scripts and Interactive Voice Response (IVR) systems.
  7. Handles escalated inquiries and appeals from consumers, agents, and private-sector partners, ensuring effective resolution.
  8. Collaborates with the agency's Administrative Procedures department regarding eligibility appeals.
  9. Formulates policies and business requirements for private-sector partners and assisters, including Navigators and Certified Application Counselors (CACs).
  10. Engages with other state agencies, such as the Department of Human Services (DHS) and Department of Community Health (DCH), to facilitate consumer referrals to and from Medicaid and Georgia Access.
  11. Performs additional duties as assigned.

Qualifications: A Master's degree in a relevant field from an accredited institution OR a Bachelor's degree in a related discipline from an accredited college or university with two years of pertinent experience OR an Associate's degree in a related field from an accredited institution with three years of relevant experience OR four years of professional experience in a related area. Note: Certain positions may necessitate specific certifications or licensure. Note: Some roles may require a valid driver's license.



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